| NPI | 1124741780 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD CLARK Medical Director 859-608-9917 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-09-20 |
| Last Update Date | 2025-07-10 |