Graduated: 2020
NPI: 1710304902
Practice Locations (2)
PRIME HEALTHCARE PHYSICIAN SERVICES - PROVIDENCE INC
3550 S 4TH ST, 200 SAINT JOHN FAMILY CARE
LEAVENWORTH, KS 660485009
9136806442
HOLISTIC PAIN MANAGEMENT OF KANSAS LLC
4101 ANDERSON AVE
MANHATTAN, KS 665037588
3074311045
Source: CMS National Downloadable File, September 2026.