| NPI | 1063543023 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SONYA C KOHL Manager 702-423-6894 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO 41657) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2017-12-20 |