Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 6183 | NV |
NPI | 1326002510 |
---|---|
Provider Name | Benjamin Alexander Hart |
First Address | Las Vegas, NV 89117-1913 |
Second Address | Las Vegas, NV 89106-4195 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2006 |
Last Update Date | 08/07/2007 |