| NPI | 1225430812 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY DAVID LATTA CIO/Member 502-416-1851 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2014-09-25 |
| Last Update Date | 2014-09-25 |