| NPI | 1821341363 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN WIRJO Manager 702-417-4091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV DO1716) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology Psychiatry (Licence: NV 12371) |
| Enumeration Date | 2012-10-22 |
| Last Update Date | 2012-10-22 |