| NPI | 1336687391 |
|---|---|
| Doing Business As | ANTI-AGING, REGENERATION AND PAIN CENTER |
| Entity Type | Organization |
| Authorized Contact | GEORGE TATAW BESONG President & CEO 386-747-9771 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: FL ME92729) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME123086) |
| 207V00000X Obstetrics & Gynecology (Licence: FL ME92729) | |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: FL ME92729) | |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2019-01-09 |