| NPI | 1003130386 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN HEENAN Business Manager 702-474-0472 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine Sports Medicine (Licence: NV 960) |
| Enumeration Date | 2010-03-16 |
| Last Update Date | 2010-03-16 |