| NPI | 1568622314 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUANITA BLAKEMAN Billing Manager 502-254-4014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: KY 32411) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 2084N0400X) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2014-01-15 |