Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 34.015170 | OH |
NPI | 1003303009 |
---|---|
Provider Name | Dr. David Aaron Heidrich |
First Address | Moraine, OH 45439-1924 |
Second Address | Kettering, OH 45429-5065 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2018 |
Last Update Date | 22/07/2021 |