| NPI | 1780336917 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT MASCARELLI Physician Assistant 573-240-6942 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2022-01-19 |
| Last Update Date | 2022-01-19 |