| NPI | 1245572866 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICK KOINOGLOU Owner 330-821-4455 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35.082293) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: OH 35.082293) |
| 363L00000X Nurse Practitioner (Licence: OH COA.14388-NP) | |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2024-01-29 |