Medical school: PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated: 1993
NPI: 1508813585
Practice Locations (1)
INTERMOUNTAIN MEDICAL HOLDINGS NEVADA INC
10105 BANBURRY CROSS DR, SUITE 460
LAS VEGAS, NV 891446645
7026919160
Source: CMS National Downloadable File, September 2026.