| NPI | 1073891081 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PETER BODNAR Manager 520-333-7723 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology (Licence: AZ 25515) |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: AZ 25515) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2022-01-26 |