Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | APRN.CNP.024218 | OH |
NPI | 1134687536 |
---|---|
Provider Name | Mr. Joshua Ryan King |
First Address | Lorain, OH 44053-1652 |
Second Address | Lorain, OH 44053-1652 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2019 |
Last Update Date | 13/05/2019 |