| NPI | 1275856270 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENYATTA DAYATRA SHAMLIN Co Owner 225-216-7885 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 025911) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: LA 202129) |
| 207R00000X Internal Medicine (Licence: LA 025910) | |
| Enumeration Date | 2010-03-04 |
| Last Update Date | 2010-03-04 |