| NPI | 1093840407 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD K LARSEN Owner 209-473-1138 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA PT86420) |
| Additional Taxonomies | 174400000X Specialist (Licence: CA PT66770) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2008-11-17 |