| NPI | 1962564401 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMARA M BURK Practice Administrator 614-505-7508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: OH 35050732) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2011-02-02 |