| NPI | 1134227440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS1244) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY15376) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2010-12-16 |