Graduated: 2003
NPI: 1437799061
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
440 NW DIVISION ST
GRESHAM, OR 970305506
5032159500
PROVIDENCE HEALTH AND SERVICES OREGON
9427 SW BARNES RD
PORTLAND, OR 972256652
Source: CMS National Downloadable File, September 2026.