Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1999
NPI: 1871123968
Practice Locations (2)
2 MARKET PLAZA WAY
MECHANICSBURG, PA 170555679
PO BOX
DALLAS, TX 75265
Source: CMS National Downloadable File, September 2026.