| NPI | 1811234032 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JEROME HANSON Owner 218-770-1006 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology Pain Medicine (Licence: MN 44547) |
| Enumeration Date | 2013-01-08 |
| Last Update Date | 2019-11-15 |