| 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 | 2025-11-21 |