| NPI | 1538235908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY 60423359) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: AZ 1655) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2016-10-31 |