Individual
TAH DAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1718 N 107TH AVE, OMAHA, NE 68114-1026
(210) 473-0043
Mailing address
1718 N 107TH AVE, OMAHA, NE 68114-1026
(210) 473-0043
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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