| NPI | 1396072500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 23462) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY60013796) |
| Enumeration Date | 2009-11-09 |
| Last Update Date | 2021-07-08 |