| NPI | 1932552296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: ME ps1523) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ME XL4625) |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2021-11-29 |