Medical school: GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE
Graduated: 2005
NPI: 1770747024
Practice Locations (1)
LAKESIDE MEDICAL ORGANIZATION A MEDICAL GROUP INC
191 S BUENA VISTA ST, SUITE 200 AND 240
BURBANK, CA 915054542
8188872671
Source: CMS National Downloadable File, September 2026.