Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | IC-544 | NV |
Y | 1041C0700X | Clinical Social Worker | IC-544 | NV |
NPI | 1003822081 |
---|---|
Provider Name | Mr. David Alexander Sturgeon |
First Address | Las Vegas, NV 89178-8737 |
Second Address | Las Vegas, NV 89128-0811 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 12/01/2010 |