| NPI | 1992191779 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONIELLE FREEDMAN Member 702-360-6003 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2021-06-23 |