| NPI | 1043331226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA 1300) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA 1300) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 1300) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2010-03-23 |