| NPI | 1134731367 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT PORTER Owner 850-631-1365 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Additional Taxonomies | 103T00000X Psychologist |
| 2084N0400X Psychiatry & Neurology, Neurology | |
| Enumeration Date | 2020-08-19 |
| Last Update Date | 2020-10-22 |