Medical school: PENNSYLVANIA COLLEGE OF OPTOMETRY
Graduated: 1994
NPI: 1922176833
Practice Locations (2)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
1221 MERCANTILE LN
LARGO, MD 207745374
3016185700
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
5100 AUTH WAY
SUITLAND, MD 207464207
3017025000
Source: CMS National Downloadable File, September 2026.