| NPI | 1376382390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: OH P.08996) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS2705) |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2026-08-11 |