Individual
USIR EL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
199 S CENTRAL AVE, COLUMBUS, OH 43223-1301
(614) 274-9500
Mailing address
1986 FOUNTAINVIEW CT APT B, COLUMBUS, OH 43232-3143
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
04/23/2019
Last updated
04/23/2019
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