Medical school: CLVLND CLINIC LERNER COLLEGE OF MED OF CASE WSTN RSV UNIVERSITY
Graduated: 1998
NPI: 1629068903
Practice Locations (1)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
1701 TWIN SPRINGS RD
HALETHORPE, MD 212273553
4107375000
Source: CMS National Downloadable File, September 2026.