| NPI | 1487270351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FERDINAND FORMOSO Owner 904-588-2393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| Additional Taxonomies | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2022-04-20 |