| NPI | 1114261203 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSAWARU OMORUYI President 502-456-0494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363LF0000X Nurse Practitioner, Family | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2015-10-02 |