| NPI | 1154782340 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY DUNGER Executive Director Finance 314-364-3707 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 208600000X Surgery |
| Enumeration Date | 2016-03-15 |
| Last Update Date | 2025-04-28 |