Medical school: MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduated: 1994
NPI: 1366477572
Practice Locations (1)
GREAT LAKES PHYSIATRISTS PC
25311 LITTLE MACK AVE, SUITE B
SAINT CLAIR SHORES, MI 480813301
5864982400111
Source: CMS National Downloadable File, September 2026.