| NPI | 1801862065 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SCOTT RADLE Practice Manager 314-878-3839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: MO R6H14) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2012-02-13 |