Graduated: 2016
NPI: 1154849313
Practice Locations (5)
PO BOX
CAROL STREAM, IL 60197
5750 JOHNSTON ST, SUITE 205
LAFAYETTE, LA 705035300
PO BOX
DETROIT, MI 48277
41800 W 11 MILE RD, SUITE 109
NOVI, MI 483751818
PO BOX
CINCINNATI, OH 45263
Source: CMS National Downloadable File, September 2026.