| NPI | 1487716098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ME CC769) |
| Additional Taxonomies | 103TS0200X Psychologist, School (Licence: ME PE549) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2026-02-10 |