| NPI | 1760858450 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK JAMES BOLTON Owner 614-855-9961 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: CA A64578) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA A64578) |
| 208D00000X General Practice (Licence: CA A64578) | |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-08-17 |