| NPI | 1912569617 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist (Licence: MA 11111) |
| 103G00000X Clinical Neuropsychologist (Licence: TX 39270) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2023-11-16 |