Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 6711 | OR |
NPI | 1003095431 |
---|---|
Provider Name | Jamal Sankari |
First Address | Eugene, OR 97440-4361 |
Second Address | Eugene, OR 97401-3606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2007 |
Last Update Date | 12/01/2011 |