Individual
NI MO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
(925) 813-6500
Mailing address
4501 SAND CREEK RD, ANTIOCH, CA 94531-8687
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
20A16690
CA
Other
Enumeration date
03/19/2017
Last updated
12/17/2021
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