| NPI | 1356443857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS1485) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: RI PS00955) |
| Enumeration Date | 2006-09-04 |
| Last Update Date | 2020-01-15 |