| NPI | 1568158202 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUAN CARLOS CORREA Md/Owner 314-698-8894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0129X Surgery, Vascular Surgery |
| Additional Taxonomies | 363LA2100X Nurse Practitioner, Acute Care |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |