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Individual
MR. MATTHEW EVAN WALLACE
Active
Individual
MR. MATTHEW EVAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP95010225
CA
Other
Enumeration date
09/14/2018
Last updated
12/10/2018
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