| NPI | 1780923490 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAREESA G KHAN Owner 636-675-3107 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VF0040X Obstetrics & Gynecology, Urogynecology and Reconstructive Pelvic Surgery (Licence: MO 112917) |
| Enumeration Date | 2013-02-01 |
| Last Update Date | 2020-07-10 |