Graduated: 1999
NPI: 1578575775
Practice Locations (2)
LEGACY CLINICS LLC
2850 SE POWELL VALLEY RD
GRESHAM, OR 970801494
5036665050
LEGACY CLINICS LLC
305 SE CHKALOV DR, SUITE 170
VANCOUVER, WA 986835263
3607993912
Source: CMS National Downloadable File, September 2026.