Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225400000X | Rehabilitation Practitioner |
NPI | 1003294018 |
---|---|
Provider Name | Myles Martin |
First Address | Las Vegas, NV 89130-3456 |
Second Address | Las Vegas, NV 89130-3456 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2015 |
Last Update Date | 11/05/2015 |