| NPI | 1295933968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA 60081984) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: CA 21569) |
| Enumeration Date | 2007-07-04 |
| Last Update Date | 2021-12-28 |