| NPI | 1487066072 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RONALD LAVOR MOON Owner 702-985-8297 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Additional Taxonomies | 246ZC0007X Specialist/Technologist, Other, Surgical Assistant (Licence: NV 132674) |
| Enumeration Date | 2014-05-30 |
| Last Update Date | 2018-06-22 |