| NPI | 1750769956 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN B MOORE Owner 316-200-7711 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: KS 0430959) |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2015-05-08 |