| NPI | 1528627882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN N GROOM Director 850-433-1656 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2023-07-19 |