Individual
ETHAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMP
Contact information
Practice address
26832 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8309
(425) 433-6583
Mailing address
26832 MAPLE VALLEY BLACK DIAMOND RD SE, MAPLE VALLEY, WA 98038-8309
(425) 433-6583
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
—
—
Other
Enumeration date
12/06/2024
Last updated
12/06/2024
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