| NPI | 1871506444 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROSALIE KREIGHBAUM Regional Credentialing Specialist 314-909-1920 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO00000565) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-05-12 |