| NPI | 1063643567 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAIME A B WILSON Prescribing Medical Psychologist 253-200-0255 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| 103TC0700X Psychologist, Clinical | |
| 251S00000X (Licence: WA 602937457) | |
| Enumeration Date | 2009-07-31 |
| Last Update Date | 2023-02-09 |