| NPI | 1891760849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: WA PY2984) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WA PY00002984) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2015-11-05 |