| NPI | 1184901951 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRUCE I KRISTOL Psychologist / V. President 904-739-5808 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: FL PY2363) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |