| 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 | 208VP0000X Pain Medicine, Pain Medicine |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2024-10-01 |