| NPI | 1063171114 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS HUHN Medical Director 502-909-0772 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2021-12-15 |