| NPI | 1154938231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA PSY10000591) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS2690) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2025-08-05 |