Medical school: UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
Graduated: 1992
NPI: 1902973811
Practice Locations (2)
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
13652 CANTARA ST
PANORAMA CITY, CA 914025423
8183752000
SOUTHERN CALIFORNIA PERMANENTE MEDICAL GROUP
12669 ENCINITAS AVE
SYLMAR, CA 913423635
8776080044
Source: CMS National Downloadable File, September 2026.