| NPI | 1467863472 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IVAN FOMITCHEV President 563-564-1283 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IA 34875) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: IA 34875) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2014-05-13 |