Medical school: WRIGHT STATE UNIVERSITY BOONSHOFT SCHOOL OF MEDICINE
Graduated: 1999
NPI: 1063406106
Practice Locations (2)
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.