| NPI | 1164517819 |
|---|---|
| Other Name | JAY WILDER |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103T00000X Psychologist (Licence: NC 3005) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NC P3005) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2020-02-27 |