| NPI | 1265672117 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH S. SHAW Practice Administrator 209-667-9339 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA 35996) |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2009-03-04 |