Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 1033695 | OK |
N | 226300000X | Kinesiotherapist | 1033695 | OK |
NPI | 1578995908 |
---|---|
Provider Name | Mr. Adrian Gheorghe Butuc |
First Address | Tulsa, OK 74146 |
Second Address | Tulsa, OK 74146 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/08/2013 |
Last Update Date | 13/08/2013 |