| NPI | 1104913417 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VIDYASHANKAR B REVAN Md / President 937-655-9179 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: OH 35080833) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-08-22 |