| NPI | 1285860007 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID WALL Sole Mbr 727-501-2347 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME48335) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: FL OS8857) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2015-11-13 |