| NPI | 1164616652 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN NISSANOFF Medical Doctor 858-451-2280 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NY G82348CA) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2016-09-07 |