| NPI | 1568047967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REGINALD M ROUSSEAU Owner 833-547-7463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2021-03-17 |
| Last Update Date | 2023-03-09 |