Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 1991
NPI: 1508859042
Practice Locations (1)
OUR LADY OF THE LAKE PHYSICIAN GROUP LLC
17609 OLD JEFFERSON HWY, SUITE D
PRAIRIEVILLE, LA 707693980
2256478511
Source: CMS National Downloadable File, September 2026.