| NPI | 1639158348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH JOSEPH VICTOR Owner 812-238-7384 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IN 20041162) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2007-11-19 |