Facts
- Status
- A
- Credential
- DO
- Type
- Individual
- Enumeration date
- 2013-04-12
- Last updated
- 2026-04-21
Licenses
- License OH
- 34.012516
- License OH
- 34.012516
Location
- Practice location
- 6700 UNIVERSITY BLVD
- City
- DUBLIN OH
- Postal code
- 430163508
- Phone
- 614-293-5123
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.