Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1996
NPI: 1972688646
Practice Locations (1)
PERMANENTE MEDICAL GROUP INC
901 NEVIN AVE
RICHMOND, CA 948013143
5103071500
Source: CMS National Downloadable File, September 2026.