| NPI | 1801352695 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON LARS ROBERG Clinical Neuropsychologist 803-708-7095 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2019-02-16 |
| Last Update Date | 2022-01-18 |