| NPI | 1689313702 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON E DELONG Sole Member 859-553-6474 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2024-07-19 |