| NPI | 1215614045 |
|---|---|
| Former Name | TYLOR JORDAN LIES-TABIT |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV ED1229) |
| Enumeration Date | 2023-07-03 |
| Last Update Date | 2023-07-03 |