NPI | 1003129479 |
---|---|
Former Name | KIMBERLY BREIDEL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY29169) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2010-07-14 |
Last Update Date | 2018-11-06 |