| NPI | 1467051391 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL THEY Pmhnp 209-718-6240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2020-10-21 |
| Last Update Date | 2023-07-18 |