| NPI | 1104839042 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WILLIAM HARRY PETTIBON Psychologist 941-922-7574 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: FL PY6096) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2007-10-23 |