| NPI | 1962683623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN M MARTIN Owner 228-826-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MS R851501) |
| Enumeration Date | 2007-11-21 |
| Last Update Date | 2007-11-21 |