| NPI | 1104962901 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CINDY P Provider Enrollment Specialist 816-271-7861 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 175F00000X Naturopath |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2016-03-14 |