Individual
ASANTE DEMETRIUS MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1421 BARRINGTON OAKS ST, NORTH LAS VEGAS, NV 89084-2043
(702) 596-0294
Mailing address
1421 BARRINGTON OAKS ST, NORTH LAS VEGAS, NV 89084-2043
(702) 596-0294
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
1403959871
NV
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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