Individual
THOMAS KOWALSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDHS
Contact information
Practice address
6767 N BASIN AVE, PORTLAND, OR 97217-3929
(503) 240-9343
Mailing address
11408 NE 128TH PL, VANCOUVER, WA 98682-1784
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
09/21/2021
Last updated
10/18/2021
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