Facts
- Status
- A
- Credential
- D.O.
- Type
- Individual
- Enumeration date
- 2011-05-10
- Last updated
- 2025-11-03
Specialties
Licenses
- License MT
- 42244
- License WA
- 56064
Location
- Practice location
- 2209 E 32ND ST
- City
- TACOMA WA
- Postal code
- 984044922
- Phone
- 253-593-0232
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
Search this city from the state hub for other records in the public registry.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.