| NPI | 1619737723 |
|---|---|
| Former Name | LOGAN JOSEPH GRONECK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-03-19 |
| Last Update Date | 2024-03-19 |