| NPI | 1821215328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME ps 743) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: ME ps 743) |
| 103TA0700X Psychologist, Adult Development & Aging (Licence: ME ps 743) | |
| 103TM1800X Psychologist, Intellectual & Developmental Disabilities (Licence: ME ps 743) | |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: ME ps 743) | |
| 103TR0400X Psychologist, Rehabilitation (Licence: ME ps 743) | |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2012-06-13 |