| NPI | 1124510623 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH PRAVOOT GIRA Chief Medical Officer 314-909-0633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2022-12-15 |