Graduated: 2020
NPI: 1013488006
Practice Locations (3)
360 COLONY LN APT, SUITE 54
Bowling Green, OH 434028915
360 COLONY LN, APT 54
BOWLING GREEN, OH 434028910
14837 DETROIT AVE, SUITE 193
LAKEWOOD, OH 441073909
Source: CMS National Downloadable File, September 2026.