| NPI | 1932759842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: PY-60967347) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA PY.60967347) |
| 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: WA PY60967347) | |
| Enumeration Date | 2019-09-13 |
| Last Update Date | 2022-02-07 |