| NPI | 1497031785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: ME CNP111091) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: ME RN52044) |
| 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: ME AP111091) | |
| Enumeration Date | 2011-10-31 |
| Last Update Date | 2020-11-12 |