| NPI | 1639610702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HEATHER WAGNER Executive Director 440-816-4906 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OH 50005004) |
| Enumeration Date | 2017-03-09 |
| Last Update Date | 2019-02-28 |