Individual
MARC BENJAMIN GONZALEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
397 BRIANNA CT, MISSOULA, MT 59804-1041
(406) 546-0883
Mailing address
397 BRIANNA CT, MISSOULA, MT 59804-1041
(406) 546-0883
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LMT-LMT-LIC-11690
MT
Other
Enumeration date
11/03/2018
Last updated
11/03/2018
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