Medical school: TUFTS UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1982
NPI: 1699782318
Practice Locations (1)
EDGEWATER SYSTEMS FOR BALANCED LIVING INC
1100 W 6TH AVE, EDGEWATER BEH HLTH SERVICES
GARY, IN 464021711
2198854264
Source: CMS National Downloadable File, September 2026.