| NPI | 1811749054 |
|---|---|
| Other Name | JACK PATRICK PETERSEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2024-04-02 |
| Last Update Date | 2024-04-02 |