Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 401 | OH |
NPI | 1043295272 |
---|---|
Provider Name | Dan L White |
First Address | Castalia, OH 44824-9232 |
Second Address | Castalia, OH 44824-9232 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 21/08/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T46448 | (02) | OH |