| NPI | 1972254662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMIR MALIK Treasurer 314-578-5416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 261QC1500X Clinic/Center, Community Health |
| Enumeration Date | 2022-01-13 |
| Last Update Date | 2022-01-13 |