| NPI | 1811179526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY00003612) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00003612) |
| 103TF0200X Psychologist, Forensic (Licence: WA PY00003612) | |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2011-05-04 |