| NPI | 1952111668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician (Licence: CA 42177) |
| Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA 722711) |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2025-01-22 |