Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT004243 | OH |
Y | 213ES0000X | Sports Medicine | AT004243 | OH |
NPI | 1457855827 |
---|---|
Provider Name | Mr. Paul Miller |
First Address | Sidney, OH 45365-2152 |
Second Address | Sidney, OH 45365-2152 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2018 |
Last Update Date | 21/03/2018 |