| NPI | 1255431144 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID MOORTHI Member LLC 585-271-1620 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: NY 214078) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine (Licence: NY 214078) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2011-03-24 |