Facts
- Status
- A
- Credential
- Ph.D.
- Type
- Individual
- Enumeration date
- 2007-02-28
- Last updated
- 2020-01-31
Specialties
Licenses
- License OH
- 6237
Location
- Practice location
- 8701 MENTOR AVE
- City
- MENTOR OH
- Postal code
- 440606103
- Phone
- 440-266-0770
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.