| NPI | 1255680054 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN MICHAEL DEMPSTER Sole Proprietor/Owner 503-724-9725 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0600X (Licence: OR MD28304) |
| Additional Taxonomies | 2084N0600X (Licence: WA md60170989) |
| Enumeration Date | 2012-09-07 |
| Last Update Date | 2012-09-07 |