Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20976 | OR |
NPI | 1003353301 |
---|---|
Provider Name | Brandon Vaughan |
First Address | Eugene, OR 97401-2901 |
Second Address | Eugene, OR 97401-2901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/01/2017 |
Last Update Date | 24/01/2017 |