| NPI | 1134421902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SOREN R. EKSTROM Sole Propietor 617-923-6086 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: MA 3505) |
| Enumeration Date | 2010-11-29 |
| Last Update Date | 2010-11-29 |