| NPI | 1932381886 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL JOHN WAICKMAN Practice Owner 330-867-3767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35-05-9856-W) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2007-12-03 |