| NPI | 1790711323 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TIMOTHY C WILSON Owner 502-868-6106 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: KY 37293) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2015-06-26 |