Graduated: 2021
NPI: 1225620032
Practice Locations (3)
200 OCEANGATE, SUITE 100
LONG BEACH, CA 908024316
1230 S I 75 BUSINESS LOOP, APT 126
GRAYLING, MI 497382025
1230 S I 75 BUSINESS LOOP APT, SUITE 126
GRAYLING, MI 497382025
Source: CMS National Downloadable File, September 2026.