Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 20017 | OR |
NPI | 1013442532 |
---|---|
Provider Name | Clifford Seretan |
First Address | Lake Oswego, OR 97035-7956 |
Second Address | Tualatin, OR 97062-8614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2017 |
Last Update Date | 21/04/2017 |