| NPI | 1114930633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME50155) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: FL PY0003384) |
| 208D00000X General Practice (Licence: FL ME0050155) | |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2017-03-27 |