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Individual

LER BWEH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
3116 N 58TH ST, OMAHA, NE 68104-3449
(402) 812-8105
Mailing address
3116 N 58TH ST, OMAHA, NE 68104-3449

Taxonomy

Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary

Other

Enumeration date
04/20/2026
Last updated
04/20/2026
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