Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC24240 | CA |
NPI | 1003032459 |
---|---|
Provider Name | Dr. Robert William Walsh |
First Address | Pleasanton, CA 94566-7762 |
Second Address | Pleasanton, CA 94566-7762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 08/07/2007 |