| NPI | 1891100871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: OR 3257) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: WA PY60461429) |
| Enumeration Date | 2014-06-27 |
| Last Update Date | 2020-09-11 |