| NPI | 1215143821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA 2014) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: OR 1515) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2015-01-21 |