NPI | 1811034481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY00003476) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00003476) |
103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY00003476) | |
Enumeration Date | 2007-01-31 |
Last Update Date | 2009-12-22 |