| NPI | 1518021237 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PEDRO SAGMIT BAULA Physican 270-769-6888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 363L00000X) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 208000000x) |
| Enumeration Date | 2006-12-20 |
| Last Update Date | 2020-08-22 |