Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 006437 | MO |
NPI | 1194095208 |
---|---|
Provider Name | Dr. George Louis Kraft III |
First Address | Saint Louis, MO 63146-3538 |
Second Address | Saint Louis, MO 63146-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2012 |
Last Update Date | 05/01/2012 |