# VANG MOUA

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1518428721
- **Gender:** Man

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 172A00000X | Driver | M0008638320601 | WI | Yes |

## Other

- **Enumeration date:** 03/29/2019
- **Last updated:** 03/29/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | M0008638320601 | DRIVER'S LICENSE | WI |