Medical school: TEXAS A & M UNIVERSITY SYSTEM, HSC, COLLEGE OF MEDICINE
Graduated: 2004
NPI: 1083923577
Practice Locations (1)
DHS OFFICE OF FINANCIAL SERVICES IRS EOPC BMRC EOTC OSH OSH-P
2600 CTR ST NE
SALEM, OR 973012669
5039452800
Source: CMS National Downloadable File, September 2026.