Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1902142789 |
---|---|
Provider Name | Endia Dickson |
First Address | Reynoldsburg, OH 43068-1589 |
Second Address | Reynoldsburg, OH 43068-1589 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2012 |
Last Update Date | 22/12/2012 |