| NPI | 1821647769 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROMER ISAAC MOSQUERA Owner 307-622-7725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 2084N0600X Psychiatry & Neurology, Clinical Neurophysiology |
| 2084P2900X Psychiatry & Neurology, Pain Medicine | |
| Enumeration Date | 2019-09-04 |
| Last Update Date | 2022-05-03 |