| NPI | 1760318679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: ME PS2656) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: ME PS2656) |
| Enumeration Date | 2026-06-18 |
| Last Update Date | 2026-07-14 |