| NPI | 1629083399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JYOTI BURRUSS Partner 502-583-1749 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207ND0900X Dermatology, Dermatopathology |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2020-07-15 |