Medical school: JEFFERSON MEDICAL COLLEGE OF THOMAS JEFFERSON UNIVERSITY
Graduated: 2004
NPI: 1922212851
Practice Locations (2)
PO BOX 8500 LOCKBOX, SUITE 7642
PHILADELPHIA, PA 19178
PO BOX 8500 LOCKBOX, SUITE 7642
PHILADELPHIA, PA 191787642
Source: CMS National Downloadable File, September 2026.