Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | 35090374 | OH |
NPI | 1114105715 |
---|---|
Provider Name | Aaron Roberts |
First Address | Dublin, OH 43017-0727 |
Second Address | Columbus, OH 43213-2197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2008 |
Last Update Date | 25/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2796854 | (05) | OH |