Graduated: 2024
NPI: 1700612041
Practice Locations (2)
LEGACY CLINICS LLC
25050 SE STARK ST, SUITE 265
GRESHAM, OR 970303388
5036742044
LEGACY SALMON CREEK HOSPITAL
2121 NE 139TH ST, SUITE 360
VANCOUVER, WA 986862316
5034137162
Source: CMS National Downloadable File, September 2026.