| NPI | 1861888331 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEKSANDER USOROV Owner/Provider 916-677-0008 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0505X Family Medicine, Adult Medicine (Licence: CA a93634) |
| Enumeration Date | 2015-04-12 |
| Last Update Date | 2016-01-12 |