Graduated: 2018
NPI: 1407344922
Practice Locations (2)
LICKING MEMORIAL PROFESSIONAL CORPORATION
1717 W MAIN ST, SUITE 203
NEWARK, OH 430551362
2205642950
SOMC MEDICAL CARE FOUNDATION, INC.
1711 27TH ST
PORTSMOUTH, OH 456622654
7403566828
Source: CMS National Downloadable File, September 2026.