Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter | C15650 | OH |
NPI | 1326007048 |
---|---|
Provider Name | Mr. Gregory Edward Bonnoront |
First Address | Sidney, OH 45365-7301 |
Second Address | Sidney, OH 45365-2731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 08/07/2007 |