Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 3101 | HI |
NPI | 1003319450 |
---|---|
Provider Name | Hans Willi Kleinert |
First Address | Honolulu, HI 96822-2101 |
Second Address | Honolulu, HI 96817-3169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2018 |
Last Update Date | 13/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3101 | HAWAII MASSAGE LICENSE (01) |