Medical school: UNIVERSITY OF TEXAS MEDICAL SCHOOL AT HOUSTON
Graduated: 2020
NPI: 1013537471
Practice Locations (3)
PO BOX, 43 MAIL ROUTE 10585
Minneapolis, MN 554400043
PO BOX, SUITE 43
MINNEAPOLIS, MN 55440
RCO PROVIDER ENROLLMENT, 2401 S 31ST ST MS AR M200
TEMPLE, TX 765080001
Source: CMS National Downloadable File, September 2026.