Medical school: NORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE
Graduated: 1990
NPI: 1619146065
Practice Locations (1)
STATE OF OHIO OFFICE OF BUDGET AND MANAGEMENT STATE ACCOUNTING
4325 GREEN ROAD COTTAGE, SUITE 3
HIGHLAND HILLS, OH 441284884
33046777132454
Source: CMS National Downloadable File, September 2026.