| NPI | 1023561966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUN WHITE Credentialing Manager 502-244-9859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: MA 230907) |
| Additional Taxonomies | 207RG0100X Internal Medicine, Gastroenterology (Licence: MA 230907) |
| Enumeration Date | 2016-07-27 |
| Last Update Date | 2016-07-27 |