{
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"FirstLineMailingAddress": "9497 COUNTY ROAD 151",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "400 W CAPITOL AVE",
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"EnumerationDate": "05/13/2025",
"LastUpdateDate": "05/13/2025",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "POWELL",
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"Taxonomies": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
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}
}