Medical school: UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated: 1994
NPI: 1194761841
Practice Locations (2)
500 S VIRGIL AVE, SUITE 503
Los Angeles, CA 900201404
500 S VIRGIL AVE, SUITE 503
LOS ANGELES, CA 900201404
2134846000
Source: CMS National Downloadable File, September 2026.