| NPI Number |
1912988684 |
| Credentials |
DO
(Doctor of Osteopathic)
|
| Entity |
Individual
|
| Enumeration date |
11/09/2005 |
| Last updated |
03/07/2023 - About 3 years ago
|
| Sole proprietor1 |
No
|
| Identifiers |
- OH License #: 34-006816-R
- OH Medicaid: 2174418
- Other: 1998 ADVANCED CARDIAC LIFE SUPPORT (ACLS) CERTIFICATION
- Other: 1998 ADVANCED LIFE SUPPORT IN OBSTETRICS (ALSO) CERTIFICATION
- Other: 1998 ADVANCED TRAUMA LIFE SUPPORT CERTIFICATION
- Other: 1999 AMERICAN ACADEMY OF ANTI-AGING MEDICINE (AAAAM)-CERTIFIED MEMBER
- Other: 1998 AMERICAN ACADEMY OF FAMILY PHYSICIANS (AAFP)
- Other: 1999 AMERICAN COLLEGE OF DISABILITY MEDICINE
- Other: 1998 AMERICAN COLLEGE OF GENERAL SURGEONS CERTIFICATION
- Other: 2001 AMERICAN MEDICAL ASSOCIATION PHYSICIAN RECOGNITION AWARD
- Other: 1997 AMERICAN MEDICAL ASSOCIATION-MEMBER
- Other: 8873 AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS (AOBFP) OSTEOPATHIC MANIPULATION
- Other: 8873 AMERICAN OSTEOPATHIC BOARD OF FAMILY PHYSICIANS USA BOARD CERTIFICATIONS
- Other: 064509 AOA # 064509 AMERICAN OSTEOPATHIC ASSOCIATION-GOOD STANDING NATIONAL
- Other: 1998 AWARD: GOLD STAR AWARD: INTERNATIONAL BIOGRAPHICAL CENTRE, CAMBRIDGE, ENGLAND
- Other: ABI AWARD: KEY OF SUCCESS, LEADER IN GOVERNMENT AND POLITICS
- Other: ABI AWARD: KEY OF SUCCESS, PROFESSIONAL PERFORMANCE
- Other: ABI AWARD: KEY TO SUCCESS, MEDICAL EXCELLENCE
- Other: 2002 AWARD: LIFE MEMEBER, NATIONAL REGISTRY OF WHO'S WHO
- Other: 2001 AWARD: ONE THOUSAND GREAT AMERICANS
- Other: 1989 AWARD: OUTSTANDING COLLEGE STUDENTS OF AMERICA
- Other: 1999 AWARD: WHO'S WHO OF INTERNATIONAL PROFESSIONAL AND BUSINESS WOMEN HONOREE
- Other: 1999 AWARD: WORLD LAUREATE OF U.S.A. FOR PERSONAL ACHIEVEMENTS AND DEDICATION SOCIETY
- Other: 1998 BASIC LIFE SUPPORT CERTIFICATION
- Other: 2000 CERTIFIED PHYSICIAN EXECUTIVE
- Other: 2007 CONSUMERS' RESEARCH COUNSIL OF AMERICA-AMERICA'S TOP FAMILY PHYSICIANS
- Other: 2006 DAV DISABLED AMERICAN VETERANS' COMMANDER'S CLUB WALL OF HONOR
- Other: 2000 DISABLED AMERICAN VETERANS, COMMANDER'S CLUB, OUTSTANDING DEVOTION & GENEROSITY
- Other: 1998 DOCTORS OF THE WORLD
- Other: 1998 FELLOW, AMERICAN SOCIETY FOR COLPOSCOPY & CERVICAL PATHOLOGY (A.S.C.C.P.)
- Other: 1998 FLIGHT FOR LIFE, STAFF FLIGHT SURGEON-EMERGENCY HELICOPTER RESCUES
- Other: 1983 MISS HARLEY-DAVIDSON U.S.A., 1ST. RUNNER UP
- Other: 29026 NATIONAL BOARD OF OSTEOPATHIC MEDICAL EXAMINERS-DIPLOMATE STATUS NATIONALLY
- Other: 1998 NEONATAL ADVANCED LIFE SUPPORT CERTIFICATION
- Other: 1998 PEDIATRIC ADVANCED LIFE SUPPORT CERTIFICATION (PALS)
- Other: 1999 PROFESSIONAL & COMPASSIONATE MEDICAL HEALTH CARE TO OUR AMERICAN VETERANS-US VA
- Other: 1997 SOCIETY OF TEACHERS OF FAMILY MEDICINE (STFM)
- MO Other: D.O. ALUMNI: KIRKSVILLE COLLEGE OF OSTEOPATHIC MEDICINE (KCOM)
- OH Other: 2010 AWARD: BEST OF WARREN MEDICAL DOCTORS
- OH Other: 1986 DEAN'S LIST FOR OUTSTANDING ACADEMIC ACHIEVEMENT: KSU KENT STATE UNIVERSITY
- OH Other: 2000 HONORARY DEPUTY SHERIFF: TRUMBULL COUNTY, OHIO
- OH Other: RE4018311 MEDICARE ASSIGNMENT
- OH Other: H051310 MEDICARE H051310 TYPE I NATIONAL
- OH Other: 000012833-00 OHIO BUREAU OF WORKERS' COMPENSATION CERTIFIED
- OH Other: 1985 RECOGNITION OF APPRECIATION FOR HEALTH SERVICES: AMERICAN RED CROSS NE TORNADO
- OH Other: 34-006816-R STATE OF OHIO MEDICAL LICENSE # 34-006816-R
- OH Other: 2002 VICE PRESIDENT, CLEVELAND SOCIETY OF CLINICAL HYPNOSIS (C.S.C.H.)
- PA Other: 1998 EXPERT WITNESS: FORENSIC ANALYSIS, STATE OF PENNSYLVANIA DEPARTMENT PROSECUTION
|
| Hospital affiliation |
n/a |
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.