| NPI | 1649849670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY61131319) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA PY61131319) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2021-09-30 |