| NPI | 1659452910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WA PY00001592) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY00001592) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2020-12-18 |