| NPI | 1639507445 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY L DWYER Credentialing Supervisor 419-824-7334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-10-15 |
| Last Update Date | 2013-10-15 |