| NPI | 1104464395 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARC NAKAGAWA CFO 662-293-7660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2019-12-18 |
| Last Update Date | 2021-05-14 |