| NPI | 1366413429 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICARDO RAO Delegated Official 314-993-9229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery Vascular Surgery (Licence: MO 103467) |
| Additional Taxonomies | 2086S0129X Surgery Vascular Surgery (Licence: MO R3J01) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2013-11-27 |