| NPI | 1710369236 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN P BOLGER Sole Owner 910-987-7285 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: SC 1237) |
| Additional Taxonomies | 103TA0700X Psychologist, Adult Development & Aging (Licence: SC 1237) |
| 103TC0700X Psychologist, Clinical (Licence: SC 1237) | |
| 103TH0004X Psychologist, Health (Licence: SC 1237) | |
| Enumeration Date | 2015-06-20 |
| Last Update Date | 2015-06-20 |