Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 225400000X | Rehabilitation Practitioner |
NPI | 1013214436 |
---|---|
Provider Name | Preston Lee Davis |
First Address | Las Vegas, NV 89127-4886 |
Second Address | Las Vegas, NV 89130-3318 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2011 |
Last Update Date | 21/02/2011 |