Individual
ELAN HO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
10215 SW PARK WAY, SUITE D, PORTLAND, OR 97225-5036
(503) 292-3583
Mailing address
2847 SE 58TH AVE, PORTLAND, OR 97206-1444
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
11438
OR
Other
Enumeration date
09/01/2011
Last updated
09/01/2011
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