Medical school: UNIVERSITY OF CALIFORNIA, DAVIS SCHOOL OF MEDICINE
Graduated: 2007
NPI: 1124214382
Practice Locations (2)
ICCO LLC
1890 NW 6TH ST
GRANTS PASS, OR 975261038
5415070684
ICCO LLC
1841 E BARNETT RD
MEDFORD, OR 975048249
5412167291
Source: CMS National Downloadable File, September 2026.