| NPI | 1114211802 |
|---|---|
| Former Name | ISABELLE BRAGG KING |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL FACCT CPY0329010311) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: MA MA 1686) |
| Enumeration Date | 2011-05-31 |
| Last Update Date | 2013-03-22 |