| NPI | 1043529696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI MCCUNE Credentialing Coordinator 419-824-7264 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207RS0010X Internal Medicine, Sports Medicine |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |