| NPI | 1417694019 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD RADIVAN Managing Director 702-307-5522 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RI0200X Internal Medicine Infectious Disease |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-05-16 |