Graduated: 2018
NPI: 1205329513
Practice Locations (2)
LICKING MEMORIAL PROFESSIONAL CORPORATION
1320 W MAIN ST
NEWARK, OH 430551822
2205644000
PROVIDENCE KIDNEY AND HYPERTENSION SPECIALISTS LLC
1406 DICKERSON ST
NEWARK, OH 430551844
7409157475
Source: CMS National Downloadable File, September 2026.