Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 21711 | AZ |
NPI | 1003322207 |
---|---|
Provider Name | Michael Yuhaniak |
First Address | Gilbert, AZ 85298-6898 |
Second Address | Gilbert, AZ 85298-6898 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 26/12/2017 |