Graduated: 2023
NPI: 1053173823
Practice Locations (2)
LEGACY CLINICS LLC
25050 SE STARK ST
GRESHAM, OR 970303383
5036741848
THE ASSOCIATION OF UNIVERSITY PHYSICIANS
825 EASTLAKE AVE E
SEATTLE, WA 981094405
2062881000
Source: CMS National Downloadable File, September 2026.