| NPI | 1265104152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMAL BALOUCH Member 406-868-5532 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2021-09-29 |