| NPI | 1457851578 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT KLICKOVICH Owner 502-430-6223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine, Interventional Pain Medicine |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine |
| 208100000X Physical Medicine & Rehabilitation | |
| 208VP0000X Pain Medicine, Pain Medicine | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2018-02-15 |
| Last Update Date | 2024-10-14 |