Medical school: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Graduated: 1993
NPI: 1699729608
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
9135 SW BARNES RD
PORTLAND, OR 972256777
PROVIDENCE HEALTH AND SERVICES OREGON
9205 SW BARNES RD
PORTLAND, OR 972256603
Source: CMS National Downloadable File, September 2026.