Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | 35091416 | OH |
Y | 208600000X | Surgeon | 35091416 | OH |
NPI | 1003072448 |
---|---|
Provider Name | Sebastian Vincent Demyttenaere |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43214-2300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2008 |
Last Update Date | 05/08/2008 |