| NPI | 1891055851 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW GERALD THORSON President/Owner 612-207-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology Pain Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| 2081P0004X Physical Medicine & Rehabilitation Spinal Cord Injury Medicine | |
| 2081P2900X Physical Medicine & Rehabilitation Pain Medicine | |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| Enumeration Date | 2012-05-24 |
| Last Update Date | 2022-02-07 |