| NPI | 1093156630 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXANDREA PARK Executive 424-245-5524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: CA 25773) |
| Additional Taxonomies | 103TH0004X Psychologist, Health (Licence: CA 25773) |
| Enumeration Date | 2013-07-11 |
| Last Update Date | 2024-01-23 |