| NPI | 1235504572 |
|---|---|
| Former Name | TIMOTHY JOSEPH JOHNSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-12-12 |
| Last Update Date | 2019-05-15 |