Medical school: UNIVERSITY OF NEBRASKA COLLEGE OF MEDICINE
Graduated: 1979
NPI: 1689767535
Practice Locations (1)
PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
3500 S 4TH ST, ST JOHNS HOSPITAL
LEAVENWORTH, KS 660485043
9136806000
Source: CMS National Downloadable File, September 2026.