Individual
LEIF ERIC PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MT
Contact information
Practice address
154 ELEU PL, KIHEI, HI 96753-8210
(808) 419-5790
Mailing address
154 ELEU PL, KIHEI, HI 96753-8210
(808) 419-5790
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MAT-16565
HI
Other
Enumeration date
12/20/2022
Last updated
12/20/2022
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