| NPI | 1699131110 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JACKSON DAVID FRASER Pa C 209-507-7000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: CA PA22498) |
| Enumeration Date | 2016-01-13 |
| Last Update Date | 2016-01-13 |