Graduated: 2012
NPI: 1558675215
Practice Locations (3)
PO BOX, SUITE 191602
SACRAMENTO, CA 958197602
15400 FOOTHILL BLVD BLDG E ROOM, SUITE 220
SAN LEANDRO, CA 945781009
885 PENNIMAN AVE, UNIT 5425
PLYMOUTH, MI 481707727
Source: CMS National Downloadable File, September 2026.