Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | MI |
NPI | 1003180654 |
---|---|
Provider Name | Donnell Cornelius |
First Address | Flint, MI 48532-4194 |
Second Address | Flint, MI 48532-4194 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/02/2012 |
Last Update Date | 29/02/2012 |