Individual
PA MASS MBYE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2475 RAMSEY RD, LINCOLN, NE 68524-6029
(402) 332-9450
Mailing address
PO BOX 939, BELLEVUE, NE 68005-0939
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
10/03/2025
Last updated
12/30/2025
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