| NPI | 1649467937 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAROL RYSER Medical Director 816-763-9165 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MO R3788) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-13367) |
| Enumeration Date | 2007-10-01 |
| Last Update Date | 2010-02-26 |