Graduated: 1995
NPI: 1548359268
Practice Locations (2)
KNOX COMMUNITY HOSPITAL
1330 COSHOCTON AVE
MOUNT VERNON, OH 430501440
LICKING MEMORIAL PROFESSIONAL CORPORATION
1320 W MAIN ST
NEWARK, OH 430551822
2205644000
Source: CMS National Downloadable File, September 2026.