Graduated: 2004
NPI: 1316071301
Practice Locations (4)
8425 WOODLAND FRST SE
ALTO, MI 493029010
100 MICHIGAN ST NE, MC 845
Grand Rapids, MI 495032560
100 MICHIGAN AVE NE
GRAND RAPIDS, MI 495032560
PO BOX, SUITE 3140
GRAND RAPIDS, MI 49501
Source: CMS National Downloadable File, September 2026.