NPI | 1992776801 |
---|---|
Entity Type | Organization |
Authorized Contact | MATTHEW BOSNER Delegated Official 314-569-1090 |
Organization Subpart ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO R6A89) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2011-09-27 |