| NPI | 1255304887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: TX 38306) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY00002256) |
| 103G00000X Clinical Neuropsychologist (Licence: TX 38306) | |
| 103TC0700X Psychologist Clinical (Licence: WA PY00002256) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2023-09-22 |