Medical school: NOVA SOUTHEASTERN UNIV COLLEGE OF DENTAL MEDICINE
Graduated: 2000
NPI: 1871577783
Practice Locations (1)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
1701 TWIN SPRINGS RD
HALETHORPE, MD 212273553
4107375000
Source: CMS National Downloadable File, September 2026.