| NPI | 1407916216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NH 907) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS1054) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2009-02-09 |