Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 2740 | OH |
NPI | 1487685350 |
---|---|
Provider Name | Joseph Francis Medina |
First Address | Canton, OH 44708 |
Second Address | Canton, OH 44708 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 25/02/2016 |