Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 16088 | CA |
N | 111NX0800X | Chiropractor Orthopedic Specialist | 16088 | CA |
NPI | 1104160795 |
---|---|
Provider Name | Dr. David Frederick Willat |
First Address | Santa Rosa, CA 95409-4350 |
Second Address | Santa Rosa, CA 95409-4350 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2012 |
Last Update Date | 20/11/2012 |