Individual
LONG LA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5000 RED ROCK ST APT 266, LAS VEGAS, NV 89118-1283
(702) 929-8800
Mailing address
5000 RED ROCK ST APT 266, LAS VEGAS, NV 89118-1283
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
07/29/2015
Last updated
07/29/2015
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