Graduated: 2024
NPI: 1679335509
Practice Locations (2)
KNOX COMMUNITY HOSPITAL
1330 COSHOCTON AVE
MOUNT VERNON, OH 430501440
7403993890
LICKING MEMORIAL PROFESSIONAL CORPORATION
1320 W MAIN ST, LICKING MEMORIAL ANESTHESIOLOGY
NEWARK, OH 430551822
2205644226
Source: CMS National Downloadable File, September 2026.