Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health |
NPI | 1184378044 |
---|---|
Provider Name | Abdul Shalamar Moss |
First Address | Las Vegas, NV 89183-7001 |
Second Address | Las Vegas, NV 89183-7001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2022 |
Last Update Date | 09/02/2022 |