Graduated: 2010
NPI: 1902127244
Practice Locations (3)
PO BOX
ATLANTA, GA 30374
711 TROY SCHENECTADY RD, SUITE 203
LATHAM, NY 121102461
110 W 97 ST, CREDENTIALING DEPARTMENT
NEW YORK, NY 100256450
Source: CMS National Downloadable File, September 2026.