Graduated: 2019
NPI: 1770043903
Practice Locations (5)
1950 W POLK ST, SUITE 78
Chicago, IL 606123723
1950 W POLK ST
CHICAGO, IL 606123723
22 BRAMHALL ST
PORTLAND, ME 041023134
PO BOX, 1309 MS 21110Q
MINNEAPOLIS, MN 554401309
12516 NE 117TH PL, APT C8
KIRKLAND, WA 980344121
Source: CMS National Downloadable File, September 2026.