| NPI | 1508047754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY ELIZABETH WILDER-WILLIS Owner 732-618-4950 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NJ 35si00446400) |
| Enumeration Date | 2007-11-15 |
| Last Update Date | 2007-11-15 |