| NPI | 1770613739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA PT 17702) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2007-07-08 |