Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 2006
NPI: 1477763795
Practice Locations (1)
PROVIDENCE HEALTH AND SERVICES OREGON
10330 SE 32ND AVE, SUITE 205
MILWAUKIE, OR 972226594
5035138950
Source: CMS National Downloadable File, September 2026.