| NPI | 1922648674 |
|---|---|
| Other Name | JEROME WILSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional |
| Additional Taxonomies | 103TF0000X Psychologist, Family (Licence: LA 38-3949990) |
| 103TF0000X Psychologist, Family | |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-01-10 |