Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | 7039 | PA |
NPI | 1306402771 |
---|---|
Provider Name | Evan Klees |
First Address | San Tan Valley, AZ 85143-4287 |
Second Address | San Tan Valley, AZ 85143-4287 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2019 |
Last Update Date | 11/05/2019 |