| NPI | 1316099435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: WA PY00002441) |
| Additional Taxonomies | 103TB0200X Psychologist Cognitive & Behavioral (Licence: WA PY00002441) |
| 103TA0700X Psychologist Adult Development & Aging (Licence: WA PY00002441) | |
| 103G00000X Clinical Neuropsychologist (Licence: WA PY00002441) | |
| Enumeration Date | 2007-01-17 |
| Last Update Date | 2010-10-14 |