| NPI | 1700930864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: ME 12821) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME 12821) |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: ME 12821) | |
| 103TC0700X Psychologist, Clinical (Licence: ME 12821) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2019-04-11 |