Medical school: UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
Graduated: 1985
NPI: 1194808923
Practice Locations (1)
LAKESIDE MEDICAL ORGANIZATION A MEDICAL GROUP INC
1500 S CENTRAL AVE, SUITE 200
GLENDALE, CA 912043853
8182914010
Source: CMS National Downloadable File, September 2026.