Graduated: 2025
NPI: 1912872524
Practice Locations (5)
PO BOX
CHICAGO, IL 60674
909 RIDGEBROOK RD, SUITE 300
SPARKS, MD 211529474
17177 N LAUREL PARK DR, SUITE 439
LIVONIA, MI 481523938
1021 BROADWAY ST
BUFFALO, NY 142121460
16 GOLD ST
BUFFALO, NY 142061420
Source: CMS National Downloadable File, September 2026.