Individual
MR. MICHAEL JONATHON LOPEZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
116 ORCHARD DR, ELIDA, OH 45807-1081
(937) 399-9217
Mailing address
116 ORCHARD DR, ELIDA, OH 45807-1081
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA.07095
OH
Other
Enumeration date
10/14/2008
Last updated
10/14/2008
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