| NPI | 1043622566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATT BRADLEY Owner 314-718-7276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0114X Orthopaedic Surgery Adult Reconstructive Orthopaedic Surgery (Licence: MO 2010008612) |
| Enumeration Date | 2014-06-02 |
| Last Update Date | 2023-09-07 |