Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1991
NPI: 1649269887
Practice Locations (1)
BOARD OF TRUSTEES OF SOUTHERN ILLINOIS UNIVERSITY
520 N 4TH ST
SPRINGFIELD, IL 627025238
2175458000
Source: CMS National Downloadable File, September 2026.