Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 005218 | MO |
NPI | 1003095936 |
---|---|
Provider Name | Evan E Gamsu |
First Address | Prairie Village, KS 66208-4363 |
Second Address | Independence, MO 64050-1769 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2007 |
Last Update Date | 27/10/2007 |