| NPI | 1265992804 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BEN JUAREZ Manager 469-296-9909 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine |
| 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2019-03-20 |