| NPI | 1205232915 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH JASON GRASSINO Owner 314-608-9438 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MO 2012008459) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 2012008459) |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2014-11-06 |