Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 3864 | NV |
NPI | 1285667881 |
---|---|
Provider Name | Mr. Koussay Mohammed Zarka |
First Address | Las Vegas, NV 89104-1948 |
Second Address | Las Vegas, NV 89104-1948 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2006 |
Last Update Date | 08/07/2007 |