| NPI | 1831300862 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PENNY SUE HOGAN Physician 937-374-6450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: OH 35071125H) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |