| NPI | 1104668870 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREA B LEWIS Credentialing Coordinator 937-554-6648 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207LP2900X Anesthesiology, Pain Medicine |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2024-08-29 |