| NPI | 1457498107 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | T. GERALD O'DANIEL Sole Proprietor 502-584-1109 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: KY 24070) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2010-10-28 |