| NPI | 1760940696 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DOUGLAS LAURIA Administrator 614-655-8956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 207QA0401X Family Medicine, Addiction Medicine | |
| 207R00000X Internal Medicine | |
| 207RA0401X Internal Medicine, Addiction Medicine | |
| 208D00000X General Practice | |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2021-01-13 |