| NPI | 1467808519 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHAD DOMANGUE Mbr 985-892-8934 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2016-05-09 |