Graduated: 1983
NPI: 1023094133
Practice Locations (2)
PROSPECT CT MEDICAL FOUNDATION INC
18 HAYNES ST, UPPR LEVEL
MANCHESTER, CT 060404111
8606497557
PROSPECT CT MEDICAL FOUNDATION INC
130 S MAIN ST
THOMASTON, CT 067871741
8602830286
Source: CMS National Downloadable File, September 2026.