| NPI | 1053645572 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTOR SHPILBERG Owner 502-937-3155 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2010-01-11 |