| NPI | 1780052811 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN C. LEPAGE Authorized Official 937-433-7536 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: OH 004150) |
| Enumeration Date | 2015-09-06 |
| Last Update Date | 2017-10-16 |