| NPI | 1316293681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA 1434) |
| Additional Taxonomies | 102L00000X Psychoanalyst (Licence: WA 1434) |
| 103TC0700X Psychologist, Clinical (Licence: WA 1434) | |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA 1434) | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2012-07-24 |