Graduated: 2025
NPI: 1326978495
Practice Locations (3)
8055 REDONDA LOOP
LAKEWOOD RANCH, FL 342022638
64 LOGAN AVE APT, 2L
Jersey City, NJ 073066945
64 LOGAN AVE, APT 2L
JERSEY CITY, NJ 073066945
Source: CMS National Downloadable File, September 2026.