Medical school: WAKE FOREST UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1977
NPI: 1700828951
Practice Locations (1)
PENN STATE HEALTH MEDICAL GROUP LLC
2605 WILLOW ST PIKE, PENN STATE MED GRP SOUTH LANCASTER
WILLOW STREET, PA 175849510
7174642838
Source: CMS National Downloadable File, September 2026.