| NPI | 1629546585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REUBEN THAKER Owner 702-545-0660 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208600000X Surgery |
| 208VP0000X Pain Medicine Pain Medicine | |
| Enumeration Date | 2018-11-08 |
| Last Update Date | 2018-11-08 |