Medical school: WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1994
NPI: 1154391381
Practice Locations (1)
BEAUMONT MEDICAL GROUP- SPECIALTY SERVICES
25631 LITTLE MACK AVE, LOWR LEVEL
SAINT CLAIR SHORES, MI 480812100
5864432998
Source: CMS National Downloadable File, September 2026.