| NPI | 1942976170 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON WILLIAMS Authorized Official 618-233-4458 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2021-08-19 |