| NPI | 1093170433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BUDI SUGENG Md 337-422-6240 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 208000000X Pediatrics (Licence: LA MD200292) |
| 363LF0000X Nurse Practitioner, Family (Licence: LA AP07807) | |
| Enumeration Date | 2015-12-30 |
| Last Update Date | 2022-10-05 |