Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1215448865 |
---|---|
Provider Name | Montanius Damond Chambers |
First Address | Las Vegas, NV 89101-1001 |
Second Address | Las Vegas, NV 89101-1001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2017 |
Last Update Date | 22/10/2017 |