| NPI | 1801226527 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EDWARD ILDOE BAE Sole Proprietor 503-646-3743 |
| Organization Subpart ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: OR AC00115) |
| Enumeration Date | 2013-11-15 |
| Last Update Date | 2014-02-04 |