Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner | NV |
NPI | 1043640097 |
---|---|
Provider Name | Kris Buxenbaum |
First Address | Las Vegas, NV 89118-5852 |
Second Address | Las Vegas, NV 89103-3826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2013 |
Last Update Date | 12/11/2013 |