Medical school: PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE
Graduated: 2001
Offers telehealth
NPI: 1578599791
Practice Locations (1)
PROVIDENCE SAINT JOHNS MEDICAL FOUNDATION
1821 WILSHIRE BLVD, SUITE 301
SANTA MONICA, CA 904035679
3108286027
Source: CMS National Downloadable File, September 2026.