| NPI | 1295890390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: HI PSY728) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA 1317) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2007-07-09 |