Graduated: 2019
NPI: 1669865168
Practice Locations (3)
1926 W BURNSIDE ST UNIT, SUITE 312
Portland, OR 972092068
10230 SE CHERRY BLOSSOM DR
PORTLAND, OR 972162821
1926 W BURNSIDE ST, UNIT 312
PORTLAND, OR 972092068
Source: CMS National Downloadable File, September 2026.