| NPI | 1902330285 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENTON D WYNN President 619-434-4019 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: CA A73257) |
| Additional Taxonomies | 261QP3300X Clinic/Center, Pain |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2017-04-13 |