Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2006-03-14
- Last updated
- 2026-01-23
Licenses
- License ND
- 20926
- License WA
- 44264
- License OR
- MD24328
Location
- Practice location
- 730 SE OAK ST STE I
- City
- HILLSBORO OR
- Postal code
- 97123
- Phone
- 034-300-4975
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.