NPI | 1821876848 |
---|---|
Entity Type | Organization |
Authorized Contact | WANDA NORGARD Credentialing 210-874-5260 |
Organization Subpart ? | No |
Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
208VP0000X | |
363LF0000X Nurse Practitioner, Family | |
363A00000X Physician Assistant | |
Enumeration Date | 2023-09-20 |
Last Update Date | 2025-09-11 |