Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 01-05076 | KS |
NPI | 1609936608 |
---|---|
Provider Name | Dr. Troy Jay Losh |
First Address | Mulvane, KS 67110-1495 |
Second Address | Mulvane, KS 67110-1495 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2006 |
Last Update Date | 14/09/2010 |