NPI | 1770102238 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 35805) |
Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
Enumeration Date | 2020-04-14 |
Last Update Date | 2020-12-08 |