| NPI | 1790773463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA WA.LIC2046) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: WA 2046) |
| 103T00000X Psychologist | |
| 103TB0200X Psychologist Cognitive & Behavioral | |
| 103TC2200X Psychologist Clinical Child & Adolescent | |
| 103TH0004X Psychologist Health | |
| 103TH0100X Psychologist Health Service | |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2012-11-14 |