Medical school: UNIVERSITY OF CALIFORNIA, IRVINE, CALIFORNIA COLLEGE OF MEDICINE
Graduated: 1996
NPI: 1376512897
Practice Locations (1)
NORTHSIDE PRIMARY CARE PROFESSIONAL SERVICES,LLC
960 JOHNSON FERRY RD, SUITE 500
ATLANTA, GA 303421630
4042570006
Source: CMS National Downloadable File, September 2026.