| NPI | 1467195370 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AQUARIUS LACEY Owner 225-400-1376 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice |
| 207Q00000X Family Medicine | |
| 305S00000X Point of Service | |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2023-04-21 |