| NPI | 1750426730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES H. SHAW Owner 419-756-8511 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2008-02-28 |