| NPI | 1265689475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARILYN M WAGNER President 502-893-4011 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: KY 0553) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2008-08-20 |