| NPI | 1215176391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: VA 0810005416) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY60140493) |
| 103G00000X Clinical Neuropsychologist (Licence: WA PY60140493) | |
| 103TC0700X Psychologist, Clinical (Licence: VA 0810005416) | |
| Enumeration Date | 2009-02-12 |
| Last Update Date | 2016-09-27 |