Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013157221 |
---|---|
Provider Name | Mr. Lucien Manson |
First Address | Burlington, VT 05401-5369 |
Second Address | Burlington, VT 05401-5369 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/02/2009 |
Last Update Date | 12/02/2015 |