Graduated: 2007
NPI: 1710147657
Practice Locations (4)
320 N MAIN AVE, SUITE 201
GRESHAM, OR 970307242
9715013590
PORTLAND, OR 97215
9715013590
3940 SE 47TH AVE
PORTLAND, OR 972063227
9715013590
PO BOX, SUITE 86785
PORTLAND, OR 97286
Source: CMS National Downloadable File, September 2026.