| NPI | 1982082400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 167G00000X Licensed Psychiatric Technician |
| Additional Taxonomies | 164W00000X Licensed Practical Nurse (Licence: NV LPN15722) |
| Enumeration Date | 2015-05-16 |
| Last Update Date | 2021-05-02 |