Graduated: 2000
NPI: 1063490878
Practice Locations (2)
DENVER HEALTH AND HOSPITAL AUTHORITY
777 BANNOCK ST
DENVER, CO 802044507
3034366000
LEGACY CLINICS LLC
2850 SE POWELL VALLEY RD
GRESHAM, OR 970801494
5036665050
Source: CMS National Downloadable File, September 2026.