| NPI | 1548750144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONALD R PETERSON CEO 916-425-3447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CA G22928) |
| Additional Taxonomies | 208D00000X General Practice (Licence: CA G22928) |
| Enumeration Date | 2018-05-18 |
| Last Update Date | 2018-05-18 |