Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 3618 | NV |
NPI | 1023533056 |
---|---|
Provider Name | Gareth Akiro Ames |
First Address | Las Vegas, NV 89128-0241 |
Second Address | Las Vegas, NV 89128-1110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2017 |
Last Update Date | 10/08/2017 |