Individual
MR. MICHAEL BOUTROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.A.C
Contact information
Practice address
2373 NJ-36, ATLANTIC HIGHLANDS, NJ 07716
(732) 872-6595
Mailing address
14 BOND PL, NORTH ARLINGTON, NJ 07031-5853
(201) 286-7183
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
25MZ00157600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MZ00157600
25MZ00157600
NJ
05
—
25MZ00157600
—
NJ
Enumeration date
03/10/2022
Last updated
03/10/2022
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