| NPI | 1760763650 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN DALE TATE Sole Member 985-229-4114 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: LA AP06135) |
| Enumeration Date | 2011-09-06 |
| Last Update Date | 2011-09-06 |