Medical school: NEW YORK COLLEGE OF OSTEO MEDICINE OF NEW YORK INSTITUTE OF TECHNOLOGY
Graduated: 1999
NPI: 1528176898
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES WASHINGTON
914 S SCHEUBER RD
CENTRALIA, WA 985319027
3607362803
PROVIDENCE HEALTH AND SERVICES WASHINGTON
525 LILLY RD NE
OLYMPIA, WA 985065101
Source: CMS National Downloadable File, September 2026.