Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 16537 | NV |
NPI | 1164721627 |
---|---|
Provider Name | Dr. Peter Shao You Su |
First Address | Las Vegas, NV 89113-3677 |
Second Address | Las Vegas, NV 89146-5612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2011 |
Last Update Date | 12/10/2021 |