Graduated: 1987
NPI: 1912992405
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
113 S HWY 101
WARRENTON, OR 971469314
5038616500
PUBLIC HOSPITAL DISTRICT 3 OF PACIFIC COUNTY
174 1ST AVE N
ILWACO, WA 986249137
3606423181
Source: CMS National Downloadable File, September 2026.