| NPI | 1235689571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS1535) |
| Additional Taxonomies | 103K00000X Behavior Analyst (Licence: ME 1-13-14831) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2018-07-20 |