Graduated: 1998
NPI: 1376855734
Practice Locations (4)
PO BOX, SUITE 776879
CHICAGO, IL 606776879
1951 BIDHOP LN, FL 4
LOUISVILLE, KY 402181923
7785 N STATE ST
LOWVILLE, NY 133671229
PO BOX, SUITE 2337
SYRACUSE, NY 13220
Source: CMS National Downloadable File, September 2026.