Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 7501003738 | MI |
NPI | 1003357963 |
---|---|
Provider Name | David White |
First Address | Battle Creek, MI 49017-9221 |
Second Address | Battle Creek, MI 49017-9221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2017 |
Last Update Date | 13/03/2017 |