Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 004519 | MO |
NPI | 1003845397 |
---|---|
Provider Name | Todd T Frisch |
First Address | Chesterfield, MO 63017-7032 |
Second Address | Chesterfield, MO 63017-7032 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2006 |
Last Update Date | 06/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
431324917 | FEDERALIDNUMBER (01) | MO |