| NPI | 1760820542 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PATRICIA LEIGH HENDERSON Member Owner 503-860-0619 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: OR PA00508) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2016-01-14 |