Medical school: PENNSYLVANIA STATE UNIVERSITY COLLEGE OF MEDICINE
Graduated: 2001
NPI: 1679663405
Practice Locations (1)
PROSPECT CHARTERCARE SJHSRI LLC
2 WAKE ROBIN RD, FATIMA HOSPITAL WOUND CARE GROUP
LINCOLN, RI 028654295
4013343830
Source: CMS National Downloadable File, September 2026.