| NPI | 1548436942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS587) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME PS587) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: ME PS587) | |
| 103TS0200X Psychologist, School (Licence: ME PS587) | |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-05-06 |