| NPI | 1134587140 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELLEY GAST President 502-588-9490 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XP3100X Orthopaedic Surgery, Pediatric Orthopaedic Surgery |
| Additional Taxonomies | 208000000X Pediatrics |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2021-09-21 |