Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1730548470 |
---|---|
Provider Name | Peshawa Kurdistani |
First Address | Saint Louis, MO 63116-2234 |
Second Address | Saint Louis, MO 63116-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2016 |
Last Update Date | 22/02/2016 |