Individual
MICHAEL LATRAE PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6767 W WINDMILL LN, LAS VEGAS, NV 89139-6501
(702) 578-0608
Mailing address
6767 W WINDMILL LN, LAS VEGAS, NV 89139-6501
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
1703509043
NV
Other
Enumeration date
08/18/2016
Last updated
08/18/2016
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