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 |