Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC23254 | CA |
NPI | 1184795783 |
---|---|
Provider Name | Dr. Michel R Gagnon |
First Address | San Jose, CA 95126-2712 |
Second Address | San Jose, CA 95126-2712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |