Medical school: NEW YORK MEDICAL COLLEGE
Graduated: 1994
NPI: 1083790083
Practice Locations (1)
SOUTHEAST HEALTH CENTER OF STODDARD COUNTY LLC
1200 N ONE MILE RD, SOUTHEAST HEALTH CENTER OF STODDARD
DEXTER, MO 638411000
5736141900
Source: CMS National Downloadable File, September 2026.