| NPI | 1083192801 |
|---|---|
| Former Name | BRADLEY LEWIS WOLF |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA 34607) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-08-02 |
| Last Update Date | 2025-10-08 |