Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 4306 | OR |
N | 225700000X | Massage Therapist | 23604 | OR |
NPI | 1124662887 |
---|---|
Provider Name | Yevgeniy Eysmont |
First Address | Portland, OR 97220-2264 |
Second Address | Portland, OR 97220-2264 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2019 |
Last Update Date | 30/03/2021 |