| NPI | 1669178984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PRAVEEN KUMAR MAMBALAM Md 425-774-1538 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2023-02-07 |
| Last Update Date | 2023-02-07 |