Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 1007 | OH |
N | 111NN1001X | Nutrition | 4366 | FL |
NPI | 1639474893 |
---|---|
Provider Name | Dr. David Alan Siegel |
First Address | Worthington, OH 43085-5743 |
Second Address | Worthington, OH 43085-5743 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2011 |
Last Update Date | 20/01/2011 |