Individual
MR. KOLOSE ILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 318-1931
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 318-1931
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
04/28/2010
Last updated
04/30/2010
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