NPI | 1871906107 |
---|---|
Former Name | JESSICA WILBUR |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: FL OS14979) |
Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: MO 2022031193) |
Enumeration Date | 2014-06-04 |
Last Update Date | 2024-07-17 |