| NPI | 1174548572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS 1233) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: PA PS016056) |
| 103TP0814X Psychologist, Psychoanalysis | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2009-04-11 |