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NPI 1386142073 · on the registry since 2018
Practice
- Address
- 200 Livingston Drive
Granville, OH 43023 - Phone
- (740) 704-0958
- Clinicians at this address
- 4
Registry record
- Primary taxonomy
- 225100000X
225100000X
- Also registered as
- 2255A2300X
390200000X - Sex
- Male
- Record last updated
- 2025-09-08
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Ohio