| NPI | 1245665306 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER O'BRIEN Billing Specialist 816-832-8804 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1411) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AR 180) |
| Enumeration Date | 2013-09-09 |
| Last Update Date | 2013-09-09 |