Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 1995
NPI: 1871678565
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 240
PORTLAND, OR 972132981
5032156480
PROVIDENCE HEALTH AND SERVICES OREGON
9205 SW BARNES RD
PORTLAND, OR 972256603
Source: CMS National Downloadable File, September 2026.