| NPI | 1861959082 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT JOHNSON Owner 702-613-2064 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 251S00000X |
| Enumeration Date | 2019-02-24 |
| Last Update Date | 2021-10-12 |