| NPI | 1073695557 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GARY RONALD JOHNSON Owner/Physican 209-754-1851 |
| Organization Subpart ? | No |
| Primary Taxonomy | 173000000X Legal Medicine (Licence: CA G27755) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2019-07-10 |