Graduated: 1999
NPI: 1023034196
Practice Locations (2)
DEACONESS ILLINOIS SPECIALTY CLINIC, INC.
3331 W DEYOUNG ST
MARION, IL 629595896
6189987600
CANTON-POTSDAM HOSPITAL
49 LAWRENCE AVE
POTSDAM, NY 136761889
3152615550
Source: CMS National Downloadable File, September 2026.