| NPI | 1902803703 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BERNARD J ROSE Physician 937-294-2555 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35052219R) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35058825R) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2010-02-23 |