| NPI | 1699744664 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RANDOLPH L ROIG Owner 985-345-0033 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: LA 09912R) |
| Additional Taxonomies | 363LG0600X Nurse Practitioner, Gerontology (Licence: AL AP04607) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2008-04-01 |