Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1993
NPI: 1578548210
Practice Locations (1)
WAKE FOREST UNIVERSITY HEALTH SCIENCES
MEDICAL CTR BLVD
WINSTON SALEM, NC 271570001
3367162734
Source: CMS National Downloadable File, September 2026.