Individual
EZRA AARON SANDBERG-LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
1433 SE TOLMAN ST, PORTLAND, OR 97202-5421
(503) 490-6372
Mailing address
1433 SE TOLMAN ST, PORTLAND, OR 97202-5421
(503) 490-6372
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16370
OR
Other
Enumeration date
10/16/2009
Last updated
10/16/2009
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