Medical school: NORTHWESTERN UNIVERSITY FEINBERG MEDICAL SCHOOL
Graduated: 1996
NPI: 1720061476
Practice Locations (1)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
13285 MINNIEVILLE RD
WOODBRIDGE, VA 221924018
7039862400
Source: CMS National Downloadable File, September 2026.