NPI | 1518159516 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00000611) |
Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY00000611) |
103TR0400X Psychologist, Rehabilitation (Licence: WA PY00000611) | |
Enumeration Date | 2007-08-14 |
Last Update Date | 2007-08-14 |