Medical school: UNIVERSITY OF KANSAS SCHOOL OF MED (KC/WICH/SAL)
Graduated: 1997
NPI: 1679666077
Practice Locations (1)
PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
913 SHEIDLEY AVE
BONNER SPRINGS, KS 660129514
9133227222
Source: CMS National Downloadable File, September 2026.