| NPI | 1497721062 |
|---|---|
| Other Name | SIMON BOLIVAR SANTOS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ MA34521) |
| Additional Taxonomies | 208600000X Surgery (Licence: NJ MA34521) |
| 208D00000X General Practice (Licence: NJ MA34521) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2012-09-19 |