| NPI | 1053741744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL PAUL WAGNER Manager 859-448-0056 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207R00000X Internal Medicine | |
| 2084N0400X Psychiatry & Neurology Neurology | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2016-02-10 |