| NPI | 1871781252 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW JOHN WELTER Docer 4357-139-1303 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 59345411205) |
| Enumeration Date | 2007-10-10 |
| Last Update Date | 2007-10-10 |