Individual
ETHAN T WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Contact information
Practice address
94-428 MOKUOLA ST STE 214A, WAIPAHU, HI 96797-3396
(808) 944-2882
Mailing address
4318 WEBB MEADOWS DR, LOGANVILLE, GA 30052-7508
(443) 208-4710
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/02/2025
Last updated
06/02/2025
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