Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Oct 27, 2023
License(s)
PA200002281 (DC), 50.008496RX (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 399 STATION 44 PL UNIT 14 | Painesville, OH 44077-2471 | 443-210-0289 |
| LOCATION | 830 W HIGH ST STE 307 | Lima, OH 45801-3979 | 419-996-4099 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.