| NPI | 1154512614 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEWIS AARON MEYERSON Owner 636-528-5281 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MO 106340) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MO 2002021114) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2008-01-16 |