Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 83667 | CA |
NPI | 1003481318 |
---|---|
Provider Name | Nidal Masri |
First Address | Los Angeles, CA 90021-2202 |
Second Address | Glendale, CA 91201-2947 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/05/2021 |
Last Update Date | 24/05/2021 |