| NPI | 1336648047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS2597) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: ME LC17038) |
| 1041C0700X Social Worker, Clinical (Licence: MO 2014012232) | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2024-11-22 |