Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 2005
NPI: 1205005642
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES WASHINGTON
413 LILLY RD NE
OLYMPIA, WA 985065133
3604934083
PROVIDENCE HEALTH AND SERVICES WASHINGTON
525 LILLY RD NE
OLYMPIA, WA 985065101
Source: CMS National Downloadable File, September 2026.