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1154902096
SHANE ALAN DAUGHERTY
DETROIT, MI
NPI
1154902096
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date
2021-04-20
Last Update Date
2021-04-20
Business Address
-- SHANE ALAN DAUGHERTY
4160 JOHN R ST STE 1017
DETROIT, MI 48201-2017
Phone number: 313-745-4123
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Mailing Address
-- SHANE ALAN DAUGHERTY
3115 W 41ST ST
ERIE, PA 16506-5315
Phone number: 724-366-2448
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