Individual
MAK MANSOURI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
8290 MAIN ST, WILLIAMSVILLE, NY 14221-6131
(716) 634-5950
Mailing address
1199 MAPLE RD, WILLIAMSVILLE, NY 14221-3441
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
013549-1
NY
Other
Enumeration date
11/25/2009
Last updated
03/23/2011
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