| NPI | 1649811803 |
|---|---|
| Former Name | ROXANA VANESSA JACOB |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: FL PY12127) |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2024-07-16 |