Medical school: UNIV OF NEBRASKA MEDICAL CENTER, COL OF DENTISTRY
Graduated: 1977
NPI: 1215081690
Practice Locations (2)
10200 GRAND CENTRAL AVE, SUITE 220
OWINGS MILLS, MD 211174165
PO BOX, SUITE 128
FORT WASHAKIE, WY 82514
Source: CMS National Downloadable File, September 2026.