Medical school: UNIVERSITY OF PIKEVILLE, KENTUCKY COLLEGE OF OSTEOPATHIC MED
Graduated: 2006
NPI: 1639371966
Practice Locations (2)
ICCO LLC
186 W ELLENDALE AVE
DALLAS, OR 973381408
5416407625
SALEM HEALTH
1002 BELLEVUE ST SE
SALEM, OR 973014006
5035615437
Source: CMS National Downloadable File, September 2026.