| NPI | 1043996986 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN NEIL GROOM Owner 850-341-4896 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2023-10-06 |