| NPI | 1790895605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY1147) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY00001147) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-08-08 |