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NPI: 1083971378 · Organization · Active

Primary Specialty

Specialist

Practice Location

7 SE 30TH AVE
PORTLAND, OR 97214-1902 Map ↗
Phone: 503-810-4941

All Specialties & Licenses

  • Specialist Primary (license: 14317, OR)

NPI Registration

Enumerated: 2012-04-12

Last CMS Update: 2012-04-12