| NPI | 1649310061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: WA 445) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA 445) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2008-03-12 |