| NPI | 1700262243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: ME PS 1448) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS 1448) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |