Medical school: UNIVERSITY OF FLORIDA COLLEGE OF MEDICINE
Graduated: 1981
NPI: 1427007764
Practice Locations (1)
PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
3500 S 4TH ST, ST JOHNS HOSPITAL
LEAVENWORTH, KS 660485043
9136806000
Source: CMS National Downloadable File, September 2026.