Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | CH61101226 | WA |
NPI | 1003416538 |
---|---|
Provider Name | Robert Martinez Molato |
First Address | Olympia, WA 98506-4632 |
Second Address | Olympia, WA 98506-4632 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2020 |
Last Update Date | 31/12/2020 |