| NPI | 1093229312 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SALLY A DEWALD Director Of Business Services 707-525-6485 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: CA 20A5942) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A5942) |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2017-11-22 |