| NPI | 1073032231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY60739170) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60739170) |
| Enumeration Date | 2017-09-19 |
| Last Update Date | 2022-08-04 |