Medical school: ILLINOIS MEDICAL COLLEGE
Graduated: 1986
NPI: 1922041599
Practice Locations (2)
6116 OAKBEND TRAIL, SUITE 112
FORT WORTH, TX 761323926
6116 OAKBEND TRL, SUITE 112
FT WORTH, TX 761323926
8173467800
Source: CMS National Downloadable File, September 2026.