Medical school: BOSTON UNIVERSITY SCHOOL OF MEDICINE
Graduated: 2004
NPI: 1962555904
Practice Locations (2)
PROVIDENCE MEDICAL INSTITUTE
GLENDALE, CA 91202
PROVIDENCE MEDICAL INSTITUTE
4101 TORRANCE BLVD
TORRANCE, CA 905034607
3103037496
Source: CMS National Downloadable File, September 2026.