| NPI | 1821443839 |
|---|---|
| Former Name | LAURA D VILLAVICENCIO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 036.152847) |
| Enumeration Date | 2016-04-27 |
| Last Update Date | 2020-09-01 |