| NPI | 1942590633 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARYL D DICHOSO Provider 888-897-2724 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2011-04-14 |
| Last Update Date | 2012-01-20 |