Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XM0800X | Mental Health |
NPI | 1205458015 |
---|---|
Provider Name | Ronald Eric Kandell |
First Address | Las Vegas, NV 89119-5154 |
Second Address | Las Vegas, NV 89119-5154 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2020 |
Last Update Date | 06/10/2021 |