Individual
FEI CAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2101 CHARLOTTE ST, KANSAS CITY, MO 64108-2727
(816) 404-7800
Mailing address
2101 CHARLOTTE ST, KANSAS CITY, MO 64108-2727
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
2021010823
MO
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
Primary
2021010823
MO
Other
Enumeration date
04/14/2017
Last updated
08/15/2022
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