| NPI | 1194877605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS-016246) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS779) |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2009-05-21 |