| NPI | 1225560949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID M BORTNICK Owner President 904-392-1687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: FL PY2065) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2020-01-06 |