Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 1999
NPI: 1659598944
Practice Locations (2)
LEGACY CLINICS LLC
24800 SE STARK ST
GRESHAM, OR 970303378
5034138988
LEGACY CLINICS LLC
1130 NW 22ND AVE, SUITE 220
PORTLAND, OR 972102969
5034138988
Source: CMS National Downloadable File, September 2026.