Medical school: RUTGERS R W JOHNSON MEDICAL SCHOOL (CAM/NEW BRUNS/PISC)
Graduated: 1985
NPI: 1932198249
Practice Locations (1)
PROVIDENCE MEDICAL FOUNDATION
2752 HARRISON AVE, SUITE A
EUREKA, CA 955014738
7144494800
Source: CMS National Downloadable File, September 2026.