Medical school: SOUTHERN ILLINOIS UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1983
NPI: 1942217310
Practice Locations (2)
380 S LAKE AVE, SUITE 211
PASADENA, CA 911013581
3102836938
1300 W 7TH ST
SAN PEDRO, CA 907323505
3105145370
Source: CMS National Downloadable File, September 2026.