| NPI | 1134895410 |
|---|---|
| Doing Business As | DTNA - PORTLAND OCC |
| Entity Type | Organization |
| Authorized Contact | JONATHAN LEIZMAN President 216-479-9063 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Enumeration Date | 2021-08-18 |
| Last Update Date | 2022-10-13 |