Medical school: UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated: 1980
NPI: 1922080480
Practice Locations (2)
FANNO CREEK CLINIC LLC
2400 SW VERMONT ST
PORTLAND, OR 972191940
5034520915
PROVIDENCE HEALTH AND SERVICES - OREGON
9205 SW BARNES RD
PORTLAND, OR 972256603
5032162213
Source: CMS National Downloadable File, September 2026.