Medical school: ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Graduated: 2004
NPI: 1992887798
Practice Locations (1)
KAISER FOUNDATION HEALTH PLAN OF THE MID ATLANTIC STATES, INC
14139 POTOMAC MILLS RD
WOODBRIDGE, VA 221924644
7032573000
Source: CMS National Downloadable File, September 2026.