Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251H1200X | Hand |
NPI | 1871685230 |
---|---|
Provider Name | Jonathan Marshall |
First Address | Fresno, CA 93720-3305 |
Second Address | Fresno, CA 93720-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0187009 | STATE OF WASHINGTON (01) | CA |