| NPI | 1902107071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY KRUGER Member 859-263-8082 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: KY 41748) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 4509) |
| 174400000X Specialist (Licence: KY 004175) | |
| Enumeration Date | 2010-11-05 |
| Last Update Date | 2010-11-05 |