| NPI | 1043762974 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ADAM SHOMSTEIN Chief Officer 314-516-3289 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: MO 2016035827) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2020-01-15 |