| 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 |