Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | NT00001520 | WA |
N | 225700000X | Massage Therapist | MA00013915 | WA |
NPI | 1073638177 |
---|---|
Provider Name | Mikhail Kisselev |
First Address | Seattle, WA 98125-6357 |
Second Address | Seattle, WA 98125-6357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 25/04/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0200908 | L&I (01) | WA |