Graduated: 2007
NPI: 1073812996
Practice Locations (4)
2727 NE SISKIYOU ST
PORTLAND, OR 972122558
916 SW KING AVE, SUITE 206
PORTLAND, OR 972051332
9713809179
PO BOX, SUITE 8459
PORTLAND, OR 972078459
PO BOX, SUITE 9
Tillamook, OR 971410009
Source: CMS National Downloadable File, September 2026.