Graduated: 1989
NPI: 1023105301
Practice Locations (4)
PO BOX
CHICAGO, IL 60677
1919 NW LOVEJOY ST, CREDENTIAL VERIFICATION SERVICES
Portland, OR 972091503
1919 NW LOVEJOY ST
PORTLAND, OR 972091503
2850 NW 31ST AVE
PORTLAND, OR 972101720
Source: CMS National Downloadable File, September 2026.