Medical school: KANSAS CITY UNIVERSITY OF MED & BIOSCIENCES, COLLEGE OF OSTEO MED
Graduated: 2006
NPI: 1265580468
Practice Locations (1)
STATE OF NEW JERSEY OMB CENTRALIZED PAYROLL
100 SULLIVAN WAY
TRENTON, NJ 086250500
6096331562
Source: CMS National Downloadable File, September 2026.