| NPI | 1104600451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH GRASSINO Owner 314-608-9438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2023-08-18 |
| Last Update Date | 2023-08-18 |