Medical school: UNIVERSITY OF WASHINGTON SCHOOL OF MEDICINE
Graduated: 1989
NPI: 1437393774
Practice Locations (2)
BROAD RIVER REHABILITATION
9120 WILLOW RIDGE RD
CHARLOTTE, NC 282108313
82877452220027
LIFESOURCE PRIME INC
3205 RANDALL PKWY, SUITE 105
WILMINGTON, NC 284032565
9107429243
Source: CMS National Downloadable File, September 2026.