Medical school: MIDWESTERN UNIVERSITY COLLEGE OF DENTAL MEDICINE, GLENDALE
Graduated: 2026
NPI: 1528984200
Practice Locations (2)
1717 S CALHOUN ST
FORT WAYNE, IN 468025257
6619 BROTHERHOOD WAY
FORT WAYNE, IN 468254226
Source: CMS National Downloadable File, September 2026.