Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1988
Offers telehealth
NPI: 1447296645
Practice Locations (1)
PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION
2701 OCEAN PARK BLVD, SUITE 118
SANTA MONICA, CA 904055219
3108298917
Source: CMS National Downloadable File, September 2026.