| NPI | 1619484649 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MANOJ BOBBY SUBBARAO WUNNAVA Physician 984-464-7972 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine (Licence: NC 2009-00892) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain (Licence: NC 2009-00892) |
| 207LA0401X Anesthesiology, Addiction Medicine (Licence: NC 2009-00892) | |
| 207L00000X Anesthesiology (Licence: NC 2009-00892) | |
| 208VP0000X (Licence: NC 2009-00892) | |
| Enumeration Date | 2017-12-28 |
| Last Update Date | 2025-09-05 |