| NPI | 1912393794 |
|---|---|
| Former Name | ANNA SERGEYEVNA SHIROKOVA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: VA 0810005557) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: VA 0810005557) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2022-07-21 |