| NPI | 1669123113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD MAUTNER Managing Member 689-208-0092 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2022-01-17 |
| Last Update Date | 2022-07-20 |