| NPI | 1659803948 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SIMONE SHARDAE MOORE Pediatric Resident 228-223-1634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2017-03-28 |
| Last Update Date | 2017-04-12 |