| NPI | 1003457698 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY F BONGIOVANNI Owner Single Member LLC 716-969-3756 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical |
| Enumeration Date | 2019-10-04 |
| Last Update Date | 2019-10-04 |