| NPI | 1154764827 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN MATTHEW BLAIR Licensed Psychologist 774-239-8605 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: MI 6301014658) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: MI 6301014658) |
| 103TF0000X Psychologist, Family (Licence: MI 6301014658) | |
| Enumeration Date | 2013-04-12 |
| Last Update Date | 2013-04-12 |