Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0102X | Surgical Critical Care | 34.014676 | OH |
NPI | 1073907564 |
---|---|
Provider Name | Dr. Brian Thomas Dusseau |
First Address | Columbus, OH 43214-3983 |
Second Address | Columbus, OH 43214-3983 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/03/2015 |
Last Update Date | 17/11/2021 |