| NPI | 1790011492 |
|---|---|
| Former Name | MARY MIGUEL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA 34032) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2009-10-30 |
| Last Update Date | 2023-03-13 |