Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XE0001X | Environmental Modification | 007132 | OH |
Y | 225XG0600X | Occupational Therapist - Gerontology | 007132 | OH |
NPI | 1164732954 |
---|---|
Provider Name | Dr. Joseph Walter Gross |
First Address | Columbus, OH 43213 |
Second Address | Columbus, OH 43213 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/10/2010 |
Last Update Date | 14/10/2010 |