| NPI | 1114757531 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MUTHUKUMAR VELLAICHAMY Sole Member 316-516-2853 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2100X Nurse Practitioner, Acute Care | |
| Enumeration Date | 2024-08-02 |
| Last Update Date | 2024-08-02 |