Individual
DANIEL PEARL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SOLE PROVIDER
Contact information
Practice address
236 MEADOWBROOK AVE, BOARDMAN, OH 44512-3004
(123) 471-9807
Mailing address
236 MEADOWBROOK AVE, BOARDMAN, OH 44512-3004
(123) 471-9807
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
RN580071
OH
Other
Enumeration date
02/22/2021
Last updated
02/22/2021
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