| NPI | 1881577815 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALEXEY MARTIN MANSO Officer Manager 702-504-6590 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2025-07-28 |
| Last Update Date | 2025-08-19 |