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 |