| NPI | 1063554947 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 364SP0807X Clinical Nurse Specialist, Psych/Mental Health, Child & Adolescent (Licence: ME CNP191213) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS847) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2020-03-19 |