| NPI | 1013417351 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OLEG MAKSIMOV Director 503-915-9217 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: OR 07-1645) |
| Additional Taxonomies | 2081P2900X Physical Medicine & Rehabilitation, Pain Medicine (Licence: OR MD28526) |
| Enumeration Date | 2018-02-13 |
| Last Update Date | 2021-05-23 |