| NPI | 1023721065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMILIE PALABASAN Member 225-371-1230 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QM0801X |
| 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder | |
| Enumeration Date | 2023-01-05 |
| Last Update Date | 2023-11-15 |