| NPI | 1780258830 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASSAD MUKHTOY Physician 314-601-4078 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry |
| Additional Taxonomies | 101YM0800X Counselor Mental Health |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2021-05-13 |