Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT005720 | OH |
Y | 213ES0000X | Sports Medicine | AT005720 | OH |
NPI | 1144784802 |
---|---|
Provider Name | Mary Josephine Soller |
First Address | Cincinnati, OH 45233-1669 |
Second Address | Cincinnati, OH 45233-1669 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2019 |
Last Update Date | 28/01/2019 |