| NPI | 1972756013 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAUL MATTHEW GIBEAU Psychologist 262-377-2006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: WI 2344-057) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: WI 2330-057) |
| Enumeration Date | 2008-11-03 |
| Last Update Date | 2008-11-03 |