Individual
JEFFREY RYAN LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HS3
Contact information
Practice address
599 TOMALES RD, PETALUMA, CA 94952-5002
(707) 765-7200
Mailing address
2 ALTA VISTA CT APT E, NOVATO, CA 94949-6531
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
DC
Other
Enumeration date
11/22/2006
Last updated
07/08/2007
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