Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist |
NPI | 1003307315 |
---|---|
Provider Name | Gul Ibrahim |
First Address | Eugene, OR 97401-3523 |
Second Address | Eugene, OR 97401-3523 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2018 |
Last Update Date | 22/05/2018 |