Individual
BEN ABA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2333 N 74TH CT APT 2, ELMWOOD PARK, IL 60707-2880
(312) 783-0287
Mailing address
2333 N 74TH CT APT 2, ELMWOOD PARK, IL 60707-2880
(312) 783-0287
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227.021229
IL
Other
Enumeration date
04/18/2022
Last updated
04/18/2022
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