| NPI | 1912202409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN TAIMOORAZY Owner 309-664-1747 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: IL 036086706) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 036086706) |
| 367500000X Nurse Anesthetist, Certified Registered | |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2015-07-21 |