103K00000X
Portland, OR
Specialty
103K00000X
Credential
BCBA, LBA
NPI
1730536913
3500 N Interstate Ave., Portland, OR 97227
(800) 813-2000Confirm current license and practice information on the official CMS NPI registry.
View NPI RecordThis surgeon specializes in 103k00000x procedures performed in an outpatient ambulatory surgical setting.
NUCC Taxonomy: 103K00000X