| NPI | 1275526949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY3311) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00052944) |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2010-10-18 |