| NPI | 1154674109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1363) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS1363) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2019-02-18 |