| NPI | 1760104251 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY GARDNER Credentialing Specialist 636-778-3634 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine |
| Enumeration Date | 2022-09-13 |
| Last Update Date | 2022-09-13 |