| NPI | 1811401136 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANSOOR A KHAN Owner 812-803-2312 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2017-11-22 |
| Last Update Date | 2019-05-31 |