| NPI | 1053811331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID ANTHONY SONGCO Owner 414-604-6413 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 3241-57) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2018-02-13 |