| NPI | 1629775580 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HASSAN ISMAIL AO 419-890-4666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center Multi-Specialty |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2023-02-10 |
| Last Update Date | 2023-08-29 |