| NPI | 1376245324 |
|---|---|
| Former Name | WADE D.H. DAZELLE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.156193) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.156193) |
| Enumeration Date | 2023-03-21 |
| Last Update Date | 2026-06-03 |