| NPI | 1487490132 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICHOLAS EDWARD PETERSON President 651-707-4042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2025-05-21 |