| NPI | 1932619327 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY Y MARYANOV Owner 479-242-3310 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207T00000X Neurological Surgery |
| Additional Taxonomies | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Enumeration Date | 2017-10-11 |
| Last Update Date | 2017-10-11 |