| NPI | 1578787560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA 802) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA 802) |
| 103TE1100X Psychologist Exercise & Sports (Licence: WA 802) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2009-08-18 |