Graduated: 2001
NPI: 1992964266
Practice Locations (2)
SOUTHWEST MISSISSIPPI REGIONAL MEDICAL CENTER
1015 DELAWARE AVE, SUITE B
MCCOMB, MS 396483827
6012504344
LICKING MEMORIAL PROFESSIONAL CORPORATION
1320 W MAIN ST
NEWARK, OH 430551822
2205644000
Source: CMS National Downloadable File, September 2026.