| NPI | 1750630851 |
|---|---|
| Former Name | JESSICA SAMUELSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MD 05857) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: VA 0810007241) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2022-09-26 |