| NPI | 1104106392 |
|---|---|
| Former Name | JESSICA MARIE BULALA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 26902) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CA PSY26902) |
| Enumeration Date | 2011-08-19 |
| Last Update Date | 2020-05-18 |