Medical school: UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
Graduated: 1991
NPI: 1346251071
Practice Locations (2)
1054 M L KING DR
CENTRALIA, IL 628013000
1054 MARTIN LUTHER KING DR, SUITE 12
CENTRALIA, IL 628013065
6185321688
Source: CMS National Downloadable File, September 2026.