Medical school: UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Graduated: 2003
NPI: 1720200025
Practice Locations (1)
PROVIDENCE HEALTH AND SERVICES OREGON
1510 DIVISION ST, SUITE 210
OREGON CITY, OR 970451599
5037236525
Source: CMS National Downloadable File, September 2026.