NPI | 1750599080 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 41784) |
Additional Taxonomies | 174400000X Specialist |
225400000X Rehabilitation Practitioner | |
Enumeration Date | 2007-05-18 |
Last Update Date | 2021-08-04 |