| NPI | 1962761668 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL L. WILSON Solo Practitioner 310-395-9590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA A21662) |
| Enumeration Date | 2012-05-15 |
| Last Update Date | 2012-05-15 |