Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 1989
NPI: 1780791764
Practice Locations (1)
CRMC MSO SUB 1 INCORPORATED
228 W 4TH ST, SUITE 200
COOKEVILLE, TN 385012489
9313720405
Source: CMS National Downloadable File, September 2026.