| NPI | 1255492716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS402) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: ME PS402) |
| 103TC0700X Psychologist, Clinical (Licence: ME PS402) | |
| 103TF0000X Psychologist, Family (Licence: ME PS402) | |
| 103TF0200X Psychologist, Forensic (Licence: ME PS402) | |
| 103TH0100X Psychologist, Health Service (Licence: ME PS402) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2009-12-22 |