| NPI | 1770705774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CA 18821) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2012-10-15 |