Medical school: WESTERN UNIVERSITY OF HEALTH SCIENCES COLLEGE OF DENTAL MED
Graduated: 1986
NPI: 1811955388
Practice Locations (1)
DHEW IND HLTH SV HLTH SVS AND MNTL HLTH ADM
4212 N 16TH ST
PHOENIX, AZ 850165319
6022631200
Source: CMS National Downloadable File, September 2026.