| NPI | 1124125109 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PANJINI M. SIVANNA President 701-297-0817 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center Ambulatory Surgical (Licence: ND 4806) |
| Additional Taxonomies | 174400000X Specialist (Licence: ND 4806) |
| 261QP3300X Clinic/Center Pain | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-05-07 |