| NPI | 1023409612 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TJ BURCH Office Manager 502-495-1162 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-02-18 |
| Last Update Date | 2020-09-04 |