| NPI | 1811753767 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIMBERLY MERCILLE Credentialing Specialist 314-226-1997 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2024-02-27 |
| Last Update Date | 2024-02-27 |