Individual
MODOU SAMBA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 W SONGBIRD ST, DERBY, KS 67037-2556
(316) 371-3853
Mailing address
402 W SONGBIRD ST, DERBY, KS 67037-2556
(316) 371-3853
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
08/17/2024
Last updated
08/17/2024
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