Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00104000 | NJ |
NPI | 1184836975 |
---|---|
Provider Name | Dr. Godfrey T. Wilson |
First Address | Princeton, NJ 08540-2907 |
Second Address | Princeton, NJ 08540-2907 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |