| NPI | 1356853683 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE R DICKISON Practice Administrator 314-808-3173 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| 207XX0005X Orthopaedic Surgery, Sports Medicine | |
| Enumeration Date | 2017-10-26 |
| Last Update Date | 2019-02-07 |