NPI | 1578986816 |
---|---|
Former Name | AMANDA NELSON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CO PSY.004275) |
Additional Taxonomies | 103T00000X Psychologist (Licence: IN 20042746A) |
103TC0700X Psychologist, Clinical (Licence: CO PSY.004275) | |
Enumeration Date | 2014-01-22 |
Last Update Date | 2021-09-10 |