Graduated: 2024
NPI: 1194556571
Practice Locations (2)
ACTIVE RECOVERY LLC
3818 HARDY ST, SUITE 20
HATTIESBURG, MS 394021539
6016024652
CREIGHTON UNIVERSITY
17055 FRANCES ST, SUITE 100
OMAHA, NE 681304655
4022803555
Source: CMS National Downloadable File, September 2026.