| NPI | 1659622124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS2658) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: UT 9695351-2501) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2025-06-23 |