| NPI | 1811220304 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXEY A RYSKIN Owner 435-656-0029 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine (Licence: UT 5566449-1205) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: UT 5566449-1205) |
| 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: UT 5566449-1205) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2009-10-26 |