Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 227.019052 | IL |
NPI | 1003577784 |
---|---|
Provider Name | Jose Raul Aguirre |
First Address | Berwyn, IL 60402-2519 |
Second Address | Berwyn, IL 60402-2519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2022 |
Last Update Date | 05/01/2022 |