Graduated: 2001
NPI: 1235211764
Practice Locations (2)
CONFEDERATED TRIBES OF THE GRAND RONDE COMMUNITY OF OREGON
9615 GRAND RONDE RD
GRAND RONDE, OR 973479712
5038792007
UNIVERSITY PROFESSIONAL SERVICES
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 972393011
5034948311
Source: CMS National Downloadable File, September 2026.