Graduated: 2025
NPI: 1215645452
Practice Locations (4)
PO BOX
CHICAGO, IL 60674
909 RIDGEBROOK RD, SUITE 300
SPARKS, MD 211529474
17177 N LAUREL PARK DR, SUITE 439
LIVONIA, MI 481523938
1814 LAFAYETTE CIR
Fairmont, WV 265548522
Source: CMS National Downloadable File, September 2026.