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Individual

MICHAEL GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
9313 MOUNTAIN RANGE AVE, LAS VEGAS, NV 89129-7833
(702) 743-9391
Mailing address
9313 MOUNTAIN RANGE AVE, LAS VEGAS, NV 89129-7833
(702) 743-9391

Taxonomy

Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9005048432
NV
05
9005051907
NV
Enumeration date
07/12/2011
Last updated
07/12/2011
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