NPI | 1922488923 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA PT26958) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA PT26958) |
Enumeration Date | 2015-06-04 |
Last Update Date | 2019-08-28 |