Individual
DAVID WILLIAM WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 THIMBLE SHOALS BLVD STE 110, NEWPORT NEWS, VA 23606-2768
(217) 417-2680
Mailing address
21600 OXNARD ST STE 1800, WOODLAND HILLS, CA 91367-7807
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
A61749540
VA
Other
Enumeration date
02/07/2018
Last updated
02/07/2018
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