| NPI | 1396125456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK D WIEDERHOLD President 858-642-0267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CA PSY16840) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2016-05-17 |