Medical school: AT STILL UN OF HLTH SCIENCES, COL OF OSTEO MED, MESA
Graduated: 2016
NPI: 1518312362
Practice Locations (1)
DHS OFFICE OF FINANCIAL SERVICES IRS EOPC BMRC EOTC OSH OSH-P
2600 CTR ST NE
SALEM, OR 973012669
5039452800
Source: CMS National Downloadable File, September 2026.