Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 70125 | CA |
NPI | 1003346297 |
---|---|
Provider Name | David Isaacson |
First Address | Whittier, CA 90601-5411 |
Second Address | Whittier, CA 90601-5411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2017 |
Last Update Date | 19/06/2017 |