| NPI | 1679921340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ND 617) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA MC60674058) |
| Enumeration Date | 2016-06-02 |
| Last Update Date | 2022-10-12 |