| NPI | 1972709376 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS L VANDER LAAN Director Physician 626-793-4136 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA G44443) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2013-04-01 |