| NPI | 1891058673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME PS1495) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MA PY 9306-PR) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2023-06-08 |