| NPI | 1952172686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RICHARDSON Partner 503-858-3642 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2024-01-11 |
| Last Update Date | 2024-01-11 |