Individual
JEFFREY JOHN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
AT/L
Contact information
Practice address
24062 TAFT RD, NOVI, MI 48375-3022
(408) 806-2583
Mailing address
37480 SCOTSDALE CIR, #301, WESTLAND, MI 48185-7553
(408) 806-2583
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
542199
MI
Other
Enumeration date
08/01/2016
Last updated
08/01/2016
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