NPI | 1932423704 |
---|---|
Former Name | LAUREN HEATHER MARCEWICZ |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2080H0002X (Licence: GA 79235) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 79235) |
2080H0002X (Licence: NY 267806) | |
Enumeration Date | 2010-03-22 |
Last Update Date | 2022-12-15 |