ETHAN RAFAEL MANGUM

LAYTON, UT
NPI1134979495
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2024-03-26
Last Update Date2024-03-26
Business Address
ETHAN RAFAEL MANGUM
1172 W SERAPHIM CT
LAYTON, UT 84041-2213
Phone number: 385-439-3790
Mailing Address
ETHAN RAFAEL MANGUM
1172 W SERAPHIM CT
LAYTON, UT 84041-2213
Phone number: 385-439-3790
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