| NPI | 1801827555 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW L PERSONIUS Owner/President 209-532-4287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine Geriatric Medicine |
| Additional Taxonomies | 364SG0600X Clinical Nurse Specialist Gerontology |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2008-04-11 |