| NPI | 1932260783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONNIE CHESER Office Manager 502-349-9999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2019-01-17 |