Medical school: INDIANA MEDICAL COLLEGE, SCHOOL OF MEDICINE OF PURDUE UNIVERSITY
Graduated: 1993
NPI: 1912103151
Practice Locations (1)
BEACON MEDICAL GROUP INC
207 N ELKHART ST, BEACON MEDICAL GROUP WAKARUSA
WAKARUSA, IN 465739729
5748622165
Source: CMS National Downloadable File, September 2026.