Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1003195538 |
---|---|
Provider Name | Michael A. D. Smith |
First Address | Las Vegas, NV 89104-6659 |
Second Address | Las Vegas, NV 89104-6659 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2011 |
Last Update Date | 18/08/2020 |