Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist | ||
N | 156F00000X | Technician/Technologist | MN |
NPI | 1093204257 |
---|---|
Provider Name | Mistir Mulatu |
First Address | Beaverton, OR 97007-8770 |
Second Address | Beaverton, OR 97007-8770 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2018 |
Last Update Date | 03/05/2018 |