| NPI | 1750765756 |
|---|---|
| Former Name | AMANDA J MARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: AL 2254) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: FL PY9225) |
| Enumeration Date | 2015-07-20 |
| Last Update Date | 2022-06-08 |