| NPI | 1629161005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOHAMMAD MOUSA Owner 318-398-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: LA 12099R) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2020-08-22 |