Graduated: 2016
NPI: 1356790695
Practice Locations (2)
CITY OF PHILADELPHIA
1900 N 20TH ST, HEALTH CARE CTR 5
PHILADELPHIA, PA 191212217
2156852973
CITY OF PHILADELPHIA
2840 W DAUPHIN ST
PHILADELPHIA, PA 191324627
2156852411
Source: CMS National Downloadable File, September 2026.