Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2005-06-13
- Last updated
- 2013-06-28
Specialties
Licenses
- License OH
- 35-08-2443
Location
- Practice location
- 1241 SHAWHAN RD
- City
- MORROW OH
- Postal code
- 451529695
- Phone
- 513-865-5204
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.