Medical school: RUTGERS R W JOHNSON MEDICAL SCHOOL (CAM/NEW BRUNS/PISC)
Graduated: 2004
NPI: 1508086067
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
1500 DIVISION ST, SUITE 220
OREGON CITY, OR 970451527
5035131900
PROVIDENCE HEALTH AND SERVICES - OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
5032151111
Source: CMS National Downloadable File, September 2026.