Graduated: 1994
NPI: 1780734491
Practice Locations (2)
COUNTY OF LOS ANGELES
12021 S WILMINGTON AVE, ROOM 1059
LOS ANGELES, CA 900593019
COUNTY OF LOS ANGELES
245 S FETTERLY AVE
LOS ANGELES, CA 900221605
3237802216
Source: CMS National Downloadable File, September 2026.