Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13758 | HI |
NPI | 1003261264 |
---|---|
Provider Name | Blake Taapai Mataoa |
First Address | Hilo, HI 96720-2900 |
Second Address | Hilo, HI 96720-4406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2016 |
Last Update Date | 25/04/2016 |