NPI | 1063508372 |
---|---|
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: MA 8253) |
Additional Taxonomies | 261QV0200X Clinic/Center, VA (Licence: MA 8253) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2017-04-13 |