| NPI | 1730588054 |
|---|---|
| Former Name | KIMBERLY LILAC WYANT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: TX 36893) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: TX 36893) |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2023-03-24 |