Medical school: SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1986
NPI: 1841452687
Practice Locations (2)
MDICS AT CIVISTA LLC
5 GARRETT AVE
LA PLATA, MD 206465960
4439490814
6 B INDUSTRIAL PARK DR, UNIT 8
WALDORF, MD 206022707
3013371219
Source: CMS National Downloadable File, September 2026.