| NPI | 1104687961 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW MINORU TAITANO Managing Member 601-953-6790 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2025-01-31 |