Individual
CANTRY ISLAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1737 GEORGETOWN RD, HUDSON, OH 44236-5013
(330) 355-9729
Mailing address
1737 GEORGETOWN RD, HUDSON, OH 44236-5013
(330) 355-9729
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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