| NPI | 1902103898 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORI A FANNIN Owner 419-468-6222 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OH 36002701) |
| Enumeration Date | 2011-02-11 |
| Last Update Date | 2011-02-11 |