| NPI | 1760738413 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WAYNE DANIEL Owner 916-564-3300 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA 20A10508) |
| Additional Taxonomies | 207QS0010X Family Medicine, Sports Medicine (Licence: CA 20A10508) |
| Enumeration Date | 2012-07-31 |
| Last Update Date | 2012-07-31 |