| NPI | 1578732426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY60424304) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00011215) |
| Enumeration Date | 2008-02-25 |
| Last Update Date | 2014-09-09 |