Medical school: WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1994
NPI: 1578555751
Practice Locations (2)
PORTAGE PHYSICIAN PRACTICES INC
500 CAMPUS DR
HANCOCK, MI 499301452
9064831060
875 LAURENCE AVE
JACKSON, MI 492022966
5177873900
Source: CMS National Downloadable File, September 2026.