Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 2020
NPI: 1326669409
Practice Locations (3)
2000 HEALTH PARK DR
BRENTWOOD, TN 370274692
P O BOX, 650859 DEPT 710
DALLAS, TX 752650859
PO BOX
DALLAS, TX 75265
Source: CMS National Downloadable File, September 2026.