NPI | 1073000261 |
---|---|
Entity Type | Organization |
Authorized Contact | DEMIAN G MOUSAD Medical Director 508-904-9036 |
Organization Subpart ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
Enumeration Date | 2018-04-13 |
Last Update Date | 2018-06-04 |