NPI | 1417572181 |
---|---|
Former Name | AMY JO BRUNO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.010957) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6352000102) |
Enumeration Date | 2020-06-09 |
Last Update Date | 2024-07-12 |