Medical school: LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT
Graduated: 2004
NPI: 1992719371
Practice Locations (1)
WAKE FOREST UNIVERSITY HEALTH SCIENCES
1404 WILLOW LN, SUITE A
NORTH WILKESBORO, NC 286593584
3366674178
Source: CMS National Downloadable File, September 2026.