Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 2013
NPI: 1285033076
Practice Locations (1)
PROVIDENCE MEDICAL GROUP
8701 TROY PIKE, SUITE 20
HUBER HEIGHTS, OH 454241073
9372375294
Source: CMS National Downloadable File, September 2026.