| NPI | 1104829514 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MISSY KNOST Practice Manager 513-475-8678 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2011-01-18 |