Individual
WARREN MICHAEL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
1281 9TH AVE UNIT 524, SAN DIEGO, CA 92101-4642
(812) 549-2072
Mailing address
1281 9TH AVE UNIT 524, SAN DIEGO, CA 92101-4642
(812) 549-2072
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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