Individual
MA OHN THA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2400 N 34TH AVE APT 54, OMAHA, NE 68111-3633
(531) 495-2375
Mailing address
3031 N 93RD ST, OMAHA, NE 68134-4715
(531) 800-5326
Taxonomy
Speciality
Code
Description
License number
State
372500000X
Chore Provider
Primary
—
—
Other
Enumeration date
03/12/2025
Last updated
03/12/2025
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