Graduated: 2021
NPI: 1922932276
Practice Locations (3)
12844 COLDWATER RD, SUITE B
FORT WAYNE, IN 468459516
4465 KEENELAND LN, UNIT 104
FORT WAYNE, IN 468451990
9823 AUBURN RD
FORT WAYNE, IN 468252347
Source: CMS National Downloadable File, September 2026.