Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | DC 20466 | CA |
NPI | 1255472494 |
---|---|
Provider Name | Mr. William Michael Gazdar |
First Address | Walnut Creek, CA 94598-3391 |
Second Address | Walnut Creek, CA 94598-3391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 08/07/2007 |