Medical school: GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1988
NPI: 1003487687
Practice Locations (4)
U S HEALTH DEPT OF HEALTH AND HUMAN SERVICES
10110 S 7650
CROE AGENCY, MT 590220009
4066384616
U S HEALTH DEPT OF HEALTH AND HUMAN SERVICES
10110 S 7650, P.O. BOX 9
CROE AGENCY, MT 590220009
SOUTHEAST INC
16 W LONG ST
COLUMBUS, OH 432152815
6142250990
SOUTHEAST INC
16 W LONG ST, FL 6
COLUMBUS, OH 432152815
Source: CMS National Downloadable File, September 2026.