Graduated: 2021
NPI: 1851972707
Practice Locations (4)
PO BOX
CHICAGO, IL 60677
2799 W GRAND BLVD
DETROIT, MI 482022608
100 MICHIGAN AVE NE
GRAND RAPIDS, MI 495032560
1148 S WASHINGTON AVE UNIT, 309B
ROYAL OAK, MI 480674146
Source: CMS National Downloadable File, September 2026.