| NPI | 1033415112 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROOKE MARIE THEODORAKOS Registered Dietitian 314-652-4100 |
| Organization Subpart ? | No |
| Primary Taxonomy | 133V00000X Dietitian, Registered (Licence: MO 2009000717) |
| Enumeration Date | 2011-02-07 |
| Last Update Date | 2011-02-07 |