| NPI | 1255803318 | 
|---|---|
| Entity Type | Organization | 
| Authorized Contact | ROBERT GROYSMAN Sole Member 469-600-6241  | 
| Organization Subpart ? | No | 
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine | 
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation | 
| 208VP0000X | |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2018-12-28 | 
| Last Update Date | 2025-03-26 |