| NPI | 1053821728 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GLENN WIGER Manager, Contracting 818-900-0681 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 103T00000X Psychologist |
| Enumeration Date | 2017-10-06 |
| Last Update Date | 2025-01-02 |