Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 35.096929 | OH |
NPI | 1750907051 |
---|---|
Provider Name | Douglas Moinuddin |
First Address | Westlake, OH 44145-0639 |
Second Address | Westlake, OH 44145-6797 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2020 |
Last Update Date | 23/06/2020 |