Mark Boulous
Mark Boulous is a Student in an Organized Health Care Education/Training Program in Peoria, Illinois. Practices as a sole proprietor. Registered with an NPI since 2024.
- In the registry since
- 2024
Practice location Address checks out
530 NE Glen Oak AvePeoria, IL 61637-0001
Phone: (309) 655-3863
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Specialties & licences
| Student in an Organized Health Care Education/Training Program (primary) | Taxonomy 390200000X |
|---|
Record details
| NPI number | 1912757642 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Male |
| Sole proprietor | Yes |
| NPI enumerated | March 25, 2024 |
| Last updated in NPPES | March 25, 2024 |
| Certification date | March 25, 2024 |
| Mailing address | 14 Cannes, Irvine, CA 92614-5398 |
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