Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 16697 | HI |
N | 225700000X | Massage Therapist | H0158935 | HI |
NPI | 1013673037 |
---|---|
Provider Name | Mr. Carl Bernard Saunders JR. |
First Address | Honolulu, HI 96815-1351 |
Second Address | Honolulu, HI 96815-1351 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/11/2021 |
Last Update Date | 14/11/2021 |