NPI | 1063303857 |
---|---|
Entity Type | Organization |
Authorized Contact | MATTHEW C BAYES Owner/Authorized Official 314-348-0594 |
Organization Subpart ? | No |
Primary Taxonomy | 2080S0010X Pediatrics Sports Medicine |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2025-07-10 |
Last Update Date | 2025-08-04 |