| NPI | 1699283804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | IHAB JOHN IBRAHIM Sole Owner 318-572-2067 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine (Licence: LA MD.14699R) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.14699R) |
| 208100000X Physical Medicine & Rehabilitation (Licence: LA MD.14699R) | |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2018-06-16 |