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1851900401
BRIAN RUSSELL
SAN DIEGO, CA
NPI
1851900401
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
103TS0200X Psychologist, School
Enumeration Date
2020-07-29
Last Update Date
2020-07-29
Business Address
BRIAN RUSSELL
4714 MOUNT ALIFAN DR
SAN DIEGO, CA 92111-2508
Phone number: 858-229-9314
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Mailing Address
BRIAN RUSSELL
4714 MOUNT ALIFAN DR
SAN DIEGO, CA 92111-2508
Phone number:
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