Medical school: TEMPLE UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1979
NPI: 1972530954
Practice Locations (2)
OLIVER STREET 5.01(A) INC
1329 S SANGRE RD, US DERMATOLOGY PARTNERS
STILLWATER, OK 740741854
4055333376
OLIVER STREET 5.01(A) INC
1367 DOMINION PLZ
TYLER, TX 757031013
9035346200
Source: CMS National Downloadable File, September 2026.