Graduated: 2014
NPI: 1992107544
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
4805 NE GLISAN ST
PORTLAND, OR 972132933
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 454
PORTLAND, OR 972132984
5032156405
Source: CMS National Downloadable File, September 2026.