| NPI | 1881030088 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SAMUEL JACK PRUDEN Owner 859-226-0206 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: KY 34192) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: KY 34192) |
| 208200000X Plastic Surgery (Licence: KY 34192) | |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2013-08-27 |