| NPI | 1053687079 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA ROSE GENISIO Pa C 314-251-6364 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MO 2012027914) |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2012-11-02 |