Graduated: 2008
NPI: 1053561993
Practice Locations (4)
500 KIRTS BLVD, SUITE 100
TROY, MI 480844142
PO BOX
TROY, MI 48099
745 HASKINS RD, SUITE B
BOWLING GREEN, OH 434021600
1900 INDIAN WOOD CIR, 202B
Maumee, OH 435374033
Source: CMS National Downloadable File, September 2026.