| NPI | 1912028861 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MELICIEN TETTAMBEL Physician 660-627-5175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: MO R9714) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MO R9714) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2020-08-22 |