| 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 |