| NPI | 1437168994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TB0200X Psychologist, Cognitive & Behavioral (Licence: ME PS 275) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS 275) |
| 103T00000X Psychologist (Licence: ME PS275) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-09 |