| NPI | 1679839229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK VINCENT GRUDBERG Member 888-342-6002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CT 3139) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2012-04-09 |