| NPI | 1902391451 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FANCIS ANDREW MITHEN Owner 314-308-7991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: MO R6152) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2019-07-30 |