Graduated: 2013
NPI: 1487997896
Practice Locations (2)
MERCY HOSPITAL
175 FORE RIVER PKWY
PORTLAND, ME 041022779
2078793000
LICKING MEMORIAL PROFESSIONAL CORPORATION
1320 W MAIN ST
NEWARK, OH 430551822
2205644000
Source: CMS National Downloadable File, September 2026.