| NPI | 1376865972 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | OSAWARU JUDE OMORUYI Owner 502-456-0494 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: KY 3006777) |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| 207R00000X Internal Medicine (Licence: KY 39870) | |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2021-01-29 |