Medical school: MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Graduated: 1994
NPI: 1750369757
Practice Locations (2)
11109 PARKVIEW PLAZA DR
FORT WAYNE, IN 468451701
11109 PARKVIEW PLAZA DR, MAILBOX 117
FORT WAYNE, IN 468451701
Source: CMS National Downloadable File, September 2026.