Graduated: 2019
NPI: 1972168219
Practice Locations (2)
LEGACY EMANUEL HOSPITAL AND HEALTH CENTER
1225 NE 2ND AVE, SUITE E 145
PORTLAND, OR 972322003
5039447199
CENTENNIAL MEDICAL GROUP INC
2700 NW STEWART PKWY
ROSEBURG, OR 974711281
5416772452
Source: CMS National Downloadable File, September 2026.