Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003212713 |
---|---|
Provider Name | Ace J David |
First Address | Las Vegas, NV 89139-0111 |
Second Address | Las Vegas, NV 89139-0111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2014 |
Last Update Date | 18/11/2014 |