Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 15565 | HI |
NPI | 1003318486 |
---|---|
Provider Name | Mr. Tysan Paaga |
First Address | Kaneohe, HI 96744-3148 |
Second Address | Kaneohe, HI 96744-6701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2018 |
Last Update Date | 01/03/2018 |