Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2020-08-02
- Last updated
- 2022-10-31
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 2123 AUBURN AVE STE 209
- City
- CINCINNATI OH
- Postal code
- 452192906
- Phone
- 512-475-8453
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.