| NPI | 1043620024 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN K DIXON Owner 606-324-4404 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology (Licence: KY 46135) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363AS0400X Physician Assistant Surgical | |
| Enumeration Date | 2014-04-30 |
| Last Update Date | 2014-09-11 |