Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PY0244 | NV |
Y | 103TC0700X | Clinical Psychologist | PY0244 | NV |
NPI | 1013047091 |
---|---|
Provider Name | Dr. Daniel T Shiode |
First Address | Las Vegas, NV 89106-4828 |
Second Address | Las Vegas, NV 89106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2007 |
Last Update Date | 19/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002602062 | (05) | NV |