| NPI | 1629497714 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL PRUDEN President 859-276-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2014-04-16 |
| Last Update Date | 2014-07-16 |