Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 35.135406 | OH |
N | 207Q00000X | Family Doctor | 57.029297 | OH |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 35.135406 | OH |
NPI | 1043751225 |
---|---|
Provider Name | Dr. Christian Erik Gausvik JR. |
First Address | Cincinnati, OH 45209-1940 |
Second Address | Cincinnati, OH 45219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2017 |
Last Update Date | 15/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0444829 | (05) | OH |