| NPI | 1336631456 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEMIAN G MOUSAD Owner 508-904-9026 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation |
| Enumeration Date | 2018-06-04 |
| Last Update Date | 2018-06-28 |