| NPI | 1528220894 |
|---|---|
| Former Name | AMANDA RAE SANDOVAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: CT 050057) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2014-07-25 |