Individual
LEI WEI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3901 RAINBOW BLVD, MAILSTOP 4015, KANSAS CITY, KS 66160-0001
(913) 588-6400
(913) 588-6414
Mailing address
3308 W 26TH ST, LAWRENCE, KS 66047-2611
(785) 842-1683
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
9406418
KS
Other
Enumeration date
05/11/2007
Last updated
07/08/2007
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