| NPI | 1013631878 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | YANCHAO FAN Owner 702-862-6166 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X |
| Additional Taxonomies | 2084A0401X Psychiatry & Neurology, Addiction Medicine |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2022-09-26 |