| NPI | 1902588379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 42603) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 42603) |
| Enumeration Date | 2023-08-03 |
| Last Update Date | 2024-06-10 |