Graduated: 2012
NPI: 1962755801
Practice Locations (2)
LEGACY CLINICS LLC
1130 NW 22ND AVE, SUITE 220
PORTLAND, OR 972102969
5034138988
LEGACY CLINICS LLC
2801 N GANTENBEIN AVE
PORTLAND, OR 972271623
5034131122
Source: CMS National Downloadable File, September 2026.