Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 2004
NPI: 1144377896
Practice Locations (3)
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
13652 CANTARA ST
PANORAMA CITY, CA 914025423
8183752000
UNIVERSITY OF UTAH ADULT SERVICES
POTOMAC, MD 20854
8015812121
UNIVERSITY OF UTAH ADULT SERVICES
50 N MEDICAL DR
SALT LAKE CITY, UT 841320100
8015856387
Source: CMS National Downloadable File, September 2026.