NPI | 1427199157 |
---|---|
Other Name | PATRICIA FAYE WALLACE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: CA PSY 16726) |
Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA PSY 16726) |
Enumeration Date | 2007-02-08 |
Last Update Date | 2015-09-01 |