Individual
GREGORY LARSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5803 W CRAIG RD, 105, LAS VEGAS, NV 89130-2536
(702) 901-5000
(702) 901-5201
Mailing address
5803 W CRAIG RD, 105, LAS VEGAS, NV 89130-2536
(702) 901-5000
(702) 901-5201
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750754107
—
NV
Enumeration date
08/18/2016
Last updated
08/18/2016
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