| NPI | 1003280512 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OTTO JOSEPH BONIN Owner 225-570-2010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care (Licence: LA AP04429) |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2015-11-20 |
| Last Update Date | 2024-07-08 |