| NPI | 1760818744 |
|---|---|
| Former Name | BRENDA GAYLE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MA 11589) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: CT 3843) |
| Enumeration Date | 2013-09-23 |
| Last Update Date | 2021-10-14 |