Individual
DI WAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2863 MANDERSON ST, OMAHA, NE 68111-2980
(402) 651-4640
Mailing address
3877 N 65TH AVE, OMAHA, NE 68104-3251
(402) 651-4640
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
NE
Other
Enumeration date
03/14/2025
Last updated
03/14/2025
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