| NPI | 1316113970 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID J FORMWALT Clinical Psychologist 251-776-1217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: AL 1104) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2008-05-05 |