Medical school: OHIO STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated: 1988
NPI: 1427124981
Practice Locations (2)
PROVIDENCE MEDICAL INSTITUTE
LAGUNA NIGUEL, CA 92677
PROVIDENCE MEDICAL INSTITUTE
18321 CLARK ST
TARZANA, CA 913563501
8188810800
Source: CMS National Downloadable File, September 2026.