| NPI | 1659789964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES GORDON Owner 036-531-8239 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2022-11-22 |