| NPI | 1124149513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS744) |
| 103TC2200X Psychologist, Clinical Child & Adolescent | |
| 103TF0000X Psychologist, Family | |
| 103TF0200X Psychologist, Forensic | |
| 103TP2701X Psychologist, Group Psychotherapy | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |