| NPI | 1831965599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 38315) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: 38315) |
| Enumeration Date | 2023-12-04 |
| Last Update Date | 2024-07-15 |