| NPI | 1962602821 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DJIEN H. SO Administrator 606-432-3221 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 207RG0300X Internal Medicine, Geriatric Medicine | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2012-11-01 |