NPI | 1588211874 |
---|---|
Former Name | NICOLE MARIE BERGAMO |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301019415) |
Additional Taxonomies | 103T00000X Psychologist (Licence: MI 6362001372) |
103T00000X Psychologist (Licence: MI 6351004559) | |
Enumeration Date | 2019-08-21 |
Last Update Date | 2024-09-12 |