Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20395 | OR |
NPI | 1013362805 |
---|---|
Provider Name | Winston Camero |
First Address | Hood River, OR 97031-1686 |
Second Address | Hood River, OR 97031-1686 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |