| NPI | 1265856447 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK ANTHONY MOORE Proprietor 267-879-4110 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: PA PS015627) |
| Enumeration Date | 2014-02-09 |
| Last Update Date | 2024-02-21 |