Medical school: UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE
Graduated: 2004
NPI: 1255315669
Practice Locations (1)
DHEW IND HLTH SV HLTH SVS AND MNTL HLTH ADM
4212 N 16TH ST
PHOENIX, AZ 850165319
6022631200
Source: CMS National Downloadable File, September 2026.