| NPI | 1851421929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIEL JOHN BRODERICK President 765-808-1687 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: IN 20041132A) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2013-07-01 |