Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 10945 | NV |
NPI | 1134180839 |
---|---|
Provider Name | Dr. Leonardo A Gan-Lim |
First Address | Las Vegas, NV 89128-0838 |
Second Address | Las Vegas, NV 89128-0835 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2006 |
Last Update Date | 01/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G18517 | (02) | NV |