| NPI | 1477106524 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALLAN MATRIANO LIM Member 318-588-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2019-07-18 |