Medical school: UNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated: 2021
NPI: 1538745542
Practice Locations (4)
1200 N STATE ST
LOS ANGELES, CA 90033
PHR GROUP PROVIDER ENROLLMENT UNIT
PASADENA, CA 911880001
PO BOX, SUITE 776351
CHICAGO, IL 606776351
1951 BIDHOP LN, FL 4
LOUISVILLE, KY 402181923
Source: CMS National Downloadable File, September 2026.