Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | 2021030134 | MO |
NPI | 1053773788 |
---|---|
Provider Name | Christina Mosher Daniel |
First Address | Saint Louis, MO 63195-7201 |
Second Address | Richmond Heights, MO 63117 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2016 |
Last Update Date | 29/10/2021 |