Graduated: 2019
NPI: 1952951030
Practice Locations (2)
LEGACY CLINICS LLC
1130 NW 22ND AVE, SUITE 220
PORTLAND, OR 972102969
5034138988
VITAL CARE, PLLC
101 NW 12TH AVE, SUITE 107
BATTLE GROUND, WA 986049141
3607230528
Source: CMS National Downloadable File, September 2026.