{
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"FirstLinePracticeLocationAddress": "2222 W GRAND RIVER AVE STE A",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-635-7618",
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"EnumerationDate": "04/25/2025",
"LastUpdateDate": "04/25/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Massage Therapist",
"LicenseNumber": null,
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}