Individual
MR. GABRIEL ISAAC WILSON I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
13160 MINDANAO WAY STE 308, MARINA DEL REY, CA 90292-7907
(310) 492-9355
Mailing address
3702 MOTOR AVE APT 19, LOS ANGELES, CA 90034-6584
(570) 335-5102
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
CA
Other
Enumeration date
06/13/2017
Last updated
06/13/2017
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