Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | 2010009148 | MO |
NPI | 1104132331 |
---|---|
Provider Name | Garima Agrawal |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2010 |
Last Update Date | 25/08/2010 |