Graduated: 1981
NPI: 1699861013
Practice Locations (5)
PO BOX
CHICAGO, IL 60674
PO BOX
CHICAGO, IL 60680
1480 RENAISSANCE DR, SUITE 211
Park Ridge, IL 600681353
1480 RENAISSANCE DR, SUITE 211
PARK RIDGE, IL 600681332
17177 N LAUREL PARK DR, SUITE 439
LIVONIA, MI 481523938
Source: CMS National Downloadable File, September 2026.