NPI | 1770613739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 17702) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2007-03-07 |
Last Update Date | 2025-09-11 |