| NPI | 1164752507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY00003829) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY00003829) |
| 103TC2200X Psychologist Clinical Child & Adolescent (Licence: WA PY00003829) | |
| Enumeration Date | 2010-01-07 |
| Last Update Date | 2013-01-10 |