Medical school: NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
Graduated: 2017
NPI: 1215474135
Practice Locations (1)
PROVIDENCE HEALTH AND SERVICES WASHINGTON
1010 S SCHEUBER RD, SUITE 3/4
CENTRALIA, WA 985318892
3608277966
Source: CMS National Downloadable File, September 2026.