| NPI | 1912449430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY WILLIAM DETWILER Psychologist 619-636-9444 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: CA PSY28289) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2016-11-15 |