Graduated: 1998
NPI: 1477586097
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
1321 NE 99TH AVE, SUITE 200
PORTLAND, OR 972209439
5032154250
PROVIDENCE HEALTH AND SERVICES OREGON
4400 NE HALSEY ST
PORTLAND, OR 972131545
Source: CMS National Downloadable File, September 2026.