Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 50.006217 | OH |
Y | 213ES0000X | Sports Medicine | 50.006217 | OH |
NPI | 1245879295 |
---|---|
Provider Name | Sean Michael Smith |
First Address | Uniontown, OH 44685-8168 |
Second Address | Canton, OH 44709-3310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2019 |
Last Update Date | 22/12/2019 |