| NPI | 1710387808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT35370) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist |
| Enumeration Date | 2014-08-26 |
| Last Update Date | 2019-02-05 |