Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 21298 | OR |
NPI | 1003274739 |
---|---|
Provider Name | Daniel Brown |
First Address | Portland, OR 97229-5987 |
Second Address | Portland, OR 97229-5987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2016 |
Last Update Date | 14/12/2016 |