Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1013179175 |
---|---|
Provider Name | David A Iler JR. |
First Address | Burbank, CA 91505-3853 |
Second Address | Burbank, CA 91505-3853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2008 |
Last Update Date | 30/06/2008 |