Medical school: VANDERBILT UNIVERSITY SCHOOL OF MEDICINE
Graduated: 2002
NPI: 1407826050
Practice Locations (2)
SOUTHERN COOS HEALTH DISTRICT
900 11TH ST SE
BANDON, OR 974119114
5413472426
PROVIDENCE HEALTH AND SERVICES - OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
5032151111
Source: CMS National Downloadable File, September 2026.