Graduated: 2018
NPI: 1376246868
Practice Locations (3)
1615 DELAWARE ST
LONGVIEW, WA 986322394
1115 SE 164TH AVE DEPT, SUITE 358
Vancouver, WA 986838004
1115 SE 164TH AVE, DEPT 358
VANCOUVER, WA 986838004
Source: CMS National Downloadable File, September 2026.