Individual
NFN LAIKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LE
Contact information
Practice address
2104C N WILLIS BLVD, PORTLAND, OR 97217-6842
(503) 251-5902
(971) 484-1929
Mailing address
2104C N WILLIS BLVD, PORTLAND, OR 97217-6842
(503) 251-5902
(971) 484-1929
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10268741
OR
Other
Enumeration date
03/17/2026
Last updated
03/17/2026
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