| NPI | 1962108118 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEVEN C MITCHELL Credentialing Manager 502-225-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084B0002X Psychiatry & Neurology, Bariatric Medicine |
| Enumeration Date | 2023-01-31 |
| Last Update Date | 2023-01-31 |