Medical school: AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
Graduated: 2004
NPI: 1457573388
Practice Locations (1)
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
520 N 4TH ST
SPRINGFIELD, IL 627025238
2175458000
Source: CMS National Downloadable File, September 2026.