Graduated: 2025
NPI: 1073304739
Practice Locations (4)
PO BOX
LOS ANGELES, CA 90088
1919 NW LOVEJOY ST
Portland, OR 972091503
2850 NW 31ST AVE
PORTLAND, OR 972101720
6305 NE 13TH AVE
PORTLAND, OR 972114101
Source: CMS National Downloadable File, September 2026.