| NPI | 1174674279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1192) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA 8077) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2020-10-13 |