Individual
KOFFI DE SOUZA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9287 NIEMAN RD, OVERLAND PARK, KS 66214-1807
(913) 937-6819
Mailing address
9287 NIEMAN RD, OVERLAND PARK, KS 66214-1807
(913) 937-6819
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
201122490B
KS
Other
Enumeration date
01/12/2016
Last updated
01/12/2016
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