Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 34.012663 | OH |
Y | 2081S0010X | Sports Medicine | 34.012663 | OH |
Y | 213ES0000X | Sports Medicine | 34.012663 | OH |
NPI | 1528472263 |
---|---|
Provider Name | Dr. Kristopher Marin |
First Address | Hamilton, OH 45013-6381 |
Second Address | Hamilton, OH 45013-6381 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 14/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0364205 | (05) | OH |