| NPI | 1255873857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY60683489) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY60683489) |
| Enumeration Date | 2016-11-14 |
| Last Update Date | 2022-05-25 |