| 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 |