Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst |
NPI | 1013213354 |
---|---|
Provider Name | Mr. Daniel Keith Martin X |
First Address | Las Vegas, NV 89138-4532 |
Second Address | Las Vegas, NV 89138-4532 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2011 |
Last Update Date | 03/02/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ABCMARTIN2 | (05) | NV |