Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1986
NPI: 1912016759
Practice Locations (1)
EDGEWATER SYSTEMS FOR BALANCED LIVING INC
1110 W 5TH AVE
GARY, IN 464021723
2198854264
Source: CMS National Downloadable File, September 2026.